# NORTHERN LAKES COOPERATIVE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CO-OP PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922044411
- **Authorized official:** MICHAEL COVELLI (GENERAL MANAGER)
- **Authorized official phone:** (715) 634-3211

## Contact information

- **Practice address:** 15846 W US HIGHWAY 63 S, HAYWARD, WI 54843-7106
- **Practice address phone:** (715) 634-8238
- **Practice address fax:** (715) 634-8170
- **Mailing address:** 15846 W US HIGHWAY 63 S, HAYWARD, WI 54843-0985
- **Mailing address phone:** (715) 634-8238
- **Mailing address fax:** (715) 634-8170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 7348-42 | WI | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 11/02/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2115372 | PK | — |
| 05 | — | 33197400 | — | WI |