52D2193400 CLIA NUMBER - NICOLET PHARMACY, INC

Laboratory Demographics

  • CLIA Code: 52D2193400
  • Facility Name: NICOLET PHARMACY, INC
  • Facility Address: 15481 COMMERCIAL ROAD, SUITE A
    LAKEWOOD, WI
    ZIP 54138
  • Facility Phone: 715 276-3646
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEREK T. LOCH
  • NPI Number: 1851321566
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2193400
LAB Type Pharmacy
Facility Name NICOLET PHARMACY, INC
Street 15481 COMMERCIAL ROAD, SUITE A
City LAKEWOOD
State WI
ZIP 54138
Phone 715 276-3646
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type Pharmacy
Lab Director DEREK T. LOCH

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This page was last updated on: 9/29/2025