NICOLET PHARMACY LONG TERM CARE
NPI 1063302990
Pharmacy - Long Term Care Pharmacy in Lakewood, WI

Q: What is Nicolet Pharmacy Long Term Care's NPI number?

The NPI number for Nicolet Pharmacy Long Term Care is 1063302990. It was assigned to this organization in the NPPES registry on July 3, 2025.

Q: What is Nicolet Pharmacy Long Term Care's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Long Term Care Pharmacy, with taxonomy code 3336L0003X.

Active since July 03, 2025CLIA 52D2193400 · Waiver

15481 COMMERCIAL RD STE A, LAKEWOOD, WI 54138(715) 276-3646(715) 276-9568 Get Directions Write a Review

NPPES record last updated: July 3, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Nicolet Pharmacy Long Term Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLET PHARMACY LONG TERM CARE (NPI 1063302990) is a healthcare organization registered as a long term care pharmacy in Lakewood, Wisconsin and active in the NPI registry since July 2025. The organization holds a CLIA Waiver certificate valid through September 20, 2026 and lists Amy J Donaldson, President, as its authorized official.

NPPES Registry Identity

NPI1063302990

Entity TypeOrganization

Primary Taxonomy3336L0003X

Legal Business NameNICOLET PHARMACY LONG TERM CARE

Location Address15481 COMMERCIAL RD STE ALakewood, WI 54138-9677

Mailing Address15481 Commercial Rd Ste ALakewood, WI 54138-9677 · (715) 276-3646 · Fax (715) 276-9568

Phone(715) 276-3646

Fax(715) 276-9568

Organization SubpartYesParent: Nicolet Pharmacy Inc

Authorized OfficialAmy J DonaldsonPresident · (715) 276-3646

Enumeration DateJuly 3, 2025

NPPES CertifiedJuly 3, 2025

✔ NPI 1063302990 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Long Term Care PharmacySuppliers

Taxonomy Code3336L0003X

Definition

A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

15481 COMMERCIAL RD STE A, Lakewood, WI 54138

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D2193400

Nicolet Pharmacy, Inc · Lakewood, WI

Active · expires Sep 20, 2026

CLIA Number52D2193400

Laboratory TypePharmacy

Certificate Effective DateSeptember 21, 2024

Certificate Expiration DateSeptember 20, 2026

Laboratory DirectorDerek T. Loch

Laboratory Phone(715) 276-3646

Laboratory LocationNicolet Pharmacy, Inc15481 Commercial Road, Suite A, Lakewood, WI 54138

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicolet Pharmacy Long Term Care's NPI number?

The NPI number for Nicolet Pharmacy Long Term Care is 1063302990. It was assigned to this organization in the NPPES registry on July 3, 2025.

Where is Nicolet Pharmacy Long Term Care located?

Nicolet Pharmacy Long Term Care is located at 15481 Commercial Rd Ste A, Lakewood, WI 54138. The listed phone number is (715) 276-3646.

What is Nicolet Pharmacy Long Term Care's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Long Term Care Pharmacy, with taxonomy code 3336L0003X.

Does Nicolet Pharmacy Long Term Care hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D2193400) is associated with this NPI, valid through September 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Nicolet Pharmacy Long Term Care accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 31 other insurers list Nicolet Pharmacy Long Term Care as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nicolet Pharmacy Long Term Care was last updated on July 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.