Healthcare Provider Details

I. General information

NPI: 1851724637
Provider Name (Legal Business Name): NICHOLAS L SMITH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 FREEDOM RD
LITTLE CHUTE WI
54140-1294
US

IV. Provider business mailing address

1914 FREEDOM RD
LITTLE CHUTE WI
54140-1294
US

V. Phone/Fax

Practice location:
  • Phone: 920-788-8888
  • Fax: 920-788-8883
Mailing address:
  • Phone: 920-788-8888
  • Fax: 920-788-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9226-42
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number9226-42
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number9226-42
License Number StateWI

VIII. Authorized Official

Name: NICHOLAS LEE SMITH
Title or Position: OWNER / PHARMACIST
Credential: PHARMD
Phone: 920-788-8888