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Organization
NORTHERN LAKES COOPERATIVE
Active
Organization
NORTHERN LAKES COOPERATIVE
Active
Other names
CO-OP PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL COVELLI (GENERAL MANAGER)
(715) 634-3211
Entity
Organization
Contact information
Practice address
15846 W US HIGHWAY 63 S, HAYWARD, WI 54843-7106
(715) 634-8238
(715) 634-8170
Mailing address
15846 W US HIGHWAY 63 S, HAYWARD, WI 54843-0985
(715) 634-8238
(715) 634-8170
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
7348-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115372
PK
—
05
—
33197400
—
WI
Enumeration date
06/21/2006
Last updated
11/02/2021
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