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Contact Information

NICOLET PHARMACY INC
15481 COMMERCIAL RD
LAKEWOOD, WI54138-9677
 Phone: 715-276-3646
 Fax: 715-276-9568
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Compounding Pharmacy

3336C0004X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for NICOLET PHARMACY INC

NPI # 1851321566
LBN Legal business name NICOLET PHARMACY INC
Authorized official GARY DONALDSON - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/05/2006
Last updated 10/10/2019 - About 7 years ago
Identifiers
WI License # 757642
WI Medicaid 33214400
Other 2115483 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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