Organization
NICOLET PHARMACY INC
Active
Other names
NICOLET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GARY DONALDSON (OWNER)
(715) 276-3646
Entity
Organization
Contact information
Practice address
15481 COMMERCIAL RD, LAKEWOOD, WI 54138-9677
(715) 276-3646
(715) 276-9568
Mailing address
15481 COMMERCIAL RD, LAKEWOOD, WI 54138-9677
(715) 276-3646
(715) 276-9568
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
757642
WI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115483
PK
—
05
—
33214400
—
WI
Enumeration date
07/05/2006
Last updated
10/10/2019
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