Nicolet Pharmacy, Inc.
Organization Active NPI Community/Retail Pharmacy · Lakewood, WI
NPI 1114290707 · NPPES record last updated Feb 14, 2012
Key facts
- NPI
- 1114290707
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 757642 (WI)
- Legal business name
- NICOLET PHARMACY, INC.
- Practice address
- 15481 Commercial Rd
Lakewood, WI 54138-9677 - Phone
- (715) 276-3646
- Fax
- (715) 276-9568
- NPI assigned
- Feb 14, 2012
- Organization subpart
- No
Authorized official
- Name
- Gary Donaldson
- Title
- President
- Phone
- (715) 276-3646
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Nicolet Pharmacy Long Term Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 757642 | WI | Yes |
Addresses
Primary practice location
15481 Commercial Rd
Lakewood, WI 54138-9677
Mailing address
15481 Commercial Rd
Lakewood, WI 54138-9677
Phone (715) 276-3646
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5133056 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names
- Nicolet Pharmacy Inc-340B Pharmacy
Other providers in Lakewood, WI
- Derek Loch
- Jodi Marie Marsh
- Lori Lee Nelson
- Nicolet Pharmacy Inc
- Nicolet Pharmacy Long Term Care
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- Lance R. Orlinski
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- Orthopedic & Spine Therapy of Lakewood, SC
All providers in Lakewood, WI · Community/Retail Pharmacy in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.