# NICOLET PHARMACY LONG TERM CARE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NICOLET PHARMACY INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063302990
- **Legal business name:** NICOLET PHARMACY INC
- **Authorized official:** AMY J DONALDSON (PRESIDENT)
- **Authorized official phone:** (715) 276-3646

## Contact information

- **Practice address:** 15481 COMMERCIAL RD STE A, LAKEWOOD, WI 54138-9677
- **Practice address phone:** (715) 276-3646
- **Practice address fax:** (715) 276-9568
- **Mailing address:** 15481 COMMERCIAL RD STE A, LAKEWOOD, WI 54138-9677
- **Mailing address phone:** (715) 276-3646
- **Mailing address fax:** (715) 276-9568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 07/03/2025
- **Last updated:** 07/03/2025