NICOLET PHARMACY, INC. (NPI# 1114290707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114290707 |
| Entity Type | Organization |
| Organization Name | NICOLET PHARMACY, INC. |
| Other Organization Name | NICOLET PHARMACY INC-340B PHARMACY |
| Practice Address |
15481 Commercial Rd Lakewood WI 54138-9677 |
| Practice Telephone | 7152763646 |
| Practice Fax Number | 7152769568 |
| Mailing Telephone | 7152763646 |
| Mailing Fax Number | 7152769568 |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |
| Authorized Official Name | GARY DONALDSON (PRESIDENT) |
| Authorized Official Telephone | 7152763646 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
757642 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP PROVIDER IDENTIFICATION NUMBER | 5133056 | 01 |
| Other Name | Type Code |
|---|---|
| Nicolet Pharmacy Inc-340B Pharmacy | Doing Business As Name - Organization |
| Street Address |
15481 COMMERCIAL RD |
| City | LAKEWOOD |
| State | WI |
| Zip Code | 54138-9677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740272848 | Jason William Nobles | Chiropractor | 15481 Commercial Rd, Ste G, Lakewood, WI 54138-9677 | 2005-08-16 |
| 1790284438 | Oconto Hospital & Medical Center Inc | Family Medicine | 15481 Commercial Rd, Lakewood, WI 54138-9677 | 2018-02-08 |
| 1326221284 | Michael W Wixom | Pharmacist | 15481 Commercial Rd, Lakewood, WI 54138-9677 | 2007-12-13 |
| 1841473717 | Gary A Donaldson | Pharmacist | 15481 Commercial Rd, Lakewood, WI 54138-9677 | 2007-12-13 |
| 1629000120 | Nobles Chiropractic Wellness Center, LLC | Chiropractor | 15481 Commercial Rd, Lakewood, WI 54138-9677 | 2006-07-07 |
| 1851321566 | Nicolet Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 15481 Commercial Rd, Lakewood, WI 54138-9677 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174830244 | Adam Robert Habeck | Chiropractor | 15267 State Hwy. 32, Lakewood, WI 54138 | 2010-09-09 |
| 1386708378 | Stacey Lee Bisenius | Dental Hygienist | 15397 State Hwy 32, Lakewood, WI 54138 | 2006-12-21 |
| 1801135371 | Habeck Chiropractic Center, LLC | Chiropractor | 15267 State Hwy. 32, Lakewood, WI 54138 | 2013-02-04 |
| 1407961402 | Leslee A Granke | Registered Nurse | 15397 State Highway 32, Lakewood, WI 54138 | 2006-08-20 |
| 1750376968 | Blake J Edinger | Dentist | 15397 State Highway 32, Lakewood, WI 54138 | 2005-09-14 |
| 1023338506 | Orthopedic & Spine Therapy of Lakewood, Sc | Physical Therapist | 17187 Twin Pines Rd, Lakewood, WI 54138-9300 | 2010-06-07 |
| 1790162899 | Assure Family Practice LLC | Clinic/Center | 17187 Twin Pines Rd, Suite A, Lakewood, WI 54138-9300 | 2015-04-28 |
| 1265841944 | Sara Piontek | Massage Therapist | 17187 Twin Pines Rd, Lakewood, WI 54138-9300 | 2014-08-07 |
| 1588975908 | Orthopedic & Spine Therapy of Lakewood, Sc | Durable Medical Equipment & Medical Supplies | 17187 Twin Pines Rd, Lakewood, WI 54138-9300 | 2010-06-30 |
| 1235458894 | Lakewood Assisted Living, LLC | Assisted Living Facility | 17185 Flynn Ln, Lakewood, WI 54138-9593 | 2010-05-21 |
| Find all providers in zip 54138 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245843150 | Tommy Ho | Pharmacy | 5864 W Mexico Ave, Lakewood, CO 80232-7044 | 2020-08-28 |
| 1023410149 | Amr Pharmacy LLC | Pharmacy | 1195 Airport Rd Ste 9b, Lakewood, NJ 08701-5970 | 2014-09-19 |
| 1609126416 | New Jersey Cvs Pharmacy LLC | Pharmacy | 596 River Ave, Lakewood, NJ 08701 | 2012-09-19 |
| 1427327568 | Ghlt LLC | Pharmacy | 1195 Route 70, Lakewood, NJ 08701-5946 | 2011-12-19 |
| 1386881746 | Costco Wholesale Corporation | Pharmacy | 340 Lakewood Center Mall, Lakewood, CA 90712 | 2009-01-07 |
| 1881721736 | Taylor Drug LLC | Pharmacy | 123 Madison Ave, Lakewood, NJ 08701-3314 | 2007-02-27 |
| 1164575403 | Westgate Pharmacy Rx LLC | Pharmacy | 112 Hillside Blvd, Lakewood, NJ 08701-3148 | 2007-01-19 |
| 1669529046 | Riser Foods Company | Pharmacy | 14100 Detroit Ave, Lakewood, OH 44107-4524 | 2007-01-05 |
| 1073605705 | New Jersey Cvs Pharmacy LLC | Pharmacy | 198 New Hampshire Ave, Lakewood, NJ 08701-3712 | 2006-09-29 |
| 1548363252 | Ohio Cvs Stores LLC | Pharmacy | 15501 Detroit Ave, Lakewood, OH 44107-3851 | 2006-09-07 |
| Find all providers in LAKEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.