NICOLET PHARMACY INC-340B PHARMACY
NPI 1114290707
Pharmacy - Community/Retail Pharmacy in Lakewood, WI

Q: What is Nicolet Pharmacy, Inc.'s NPI number?

The NPI number for Nicolet Pharmacy, Inc. is 1114290707. It was assigned to this organization in the NPPES registry on February 14, 2012. The provider is doing business as Nicolet Pharmacy Inc-340b Pharmacy.

Q: What is Nicolet Pharmacy, Inc.'s specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Active since February 14, 2012

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

NPPES record last updated: February 14, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Nicolet Pharmacy Inc-340b Pharmacy NPPES

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

NICOLET PHARMACY INC-340B PHARMACY (NPI 1114290707) is a healthcare organization registered as a community/retail pharmacy in Lakewood, Wisconsin and active in the NPI registry since February 2012. The organization lists Gary Donaldson, President, as its authorized official.

NPPES Registry Identity

NPI1114290707

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameNICOLET PHARMACY, INC.

Location Address15481 COMMERCIAL RDLakewood, WI 54138-9677

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

Phone(715) 276-3646

Fax(715) 276-9568

Organization SubpartNo

Authorized OfficialGary DonaldsonPresident · (715) 276-3646

Enumeration DateFebruary 14, 2012

✔ NPI 1114290707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in WI · 757642

Definition

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.

15481 COMMERCIAL RD, Lakewood, WI 54138

Open in Google Maps ↗

Other Names 1

Doing Business AsNicolet Pharmacy Inc-340b Pharmacy

Other Identifiers 1

Other5133056Ncpdp Provider Identification Number

Medical Equipment Supplier Medicare DMEPOS 16

Medicare supplier enrollment and the product categories Nicolet Pharmacy carries, from the Medicare DMEPOS supplier directory.

Nicolet Pharmacy

DMEPOS supplier · Lakewood, WIOperated by Nicolet Pharmacy, Inc.

✔

Accepts Medicare assignment

Nicolet Pharmacy agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20618195

Medicare Participant SinceJanuary 1, 2001

Supplier Location15481 Commercial Rd Suite ALakewood, WI 54138

Phone(715) 276-3646

Supplier Specialties

Pharmacy

Medicare Product Categories

Blood Glucose Monitors/Supplies (Non-Mail Order)

Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device

Insulin Infusion Pumps and/or Supplies

Disposable Insulin Delivery System, Mechanical insulin infusion pumps, Needle type infusion sets, Cannula type infusion sets

Support Surfaces: Pressure Reducing Beds/Mats/Pads

Group 1 – Alternating pressure pad, Air/Water/Dry pressure pad or pressure mattress. Group 2 - Pressure reducing powered air mattresses, Powered air flotation bed, non-powered pressure reducing mattress Group 3 – Air fluidized bed

(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies

Transcutaneous Electrical Nerve Stimulation (TENS) for the relief of acute post-operative pain

Canes and/or Crutches

Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches

Walkers

Standard Walkers, Wheeled Walkers, Folding Walker

Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. MICHAEL W WIXOM RPH

Pharmacist