Nicolet Pharmacy Inc-340B Pharmacy

LBN: Nicolet Pharmacy, Inc.
Nicolet Pharmacy Inc-340B Pharmacy is an health care organization with primary practice located at 15481 Commercial Rd , Lakewood WI 54138-9677. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Nicolet Pharmacy, Inc. can be contacted via phone (715) 276-3646, or through Donaldson, Gary via phone (715) 276-3646.

Contact Information

Primary practice address
15481 Commercial Rd Lakewood WI 54138-9677
Phone: (715) 276-3646
Fax: (715) 276-9568
Website:
Map and Directions
Authorized official contact:
Name: Donaldson, Gary
Phone: (715) 276-3646

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 757642 Wisconsin

Profile Details

NPI number 1114290707
LBN Legal business name Nicolet Pharmacy, Inc.
DBA Doing business as Nicolet Pharmacy Inc-340B Pharmacy
Authorized official Donaldson, Gary
Entity Organization
Organization subpart 1 No
Enumeration date Feb 14th, 2012
Last updated Feb 14th, 2012 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114290707 NPPES
Other 5133056 NCPDP PROVIDER IDENTIFICATION NUMBER

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