# MAIN STREET PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013192715
- **Authorized official:** CINDY KISSACK RPH (OWNER)
- **Authorized official phone:** (608) 524-1616

## Contact information

- **Practice address:** 140 E MAIN ST, REEDSBURG, WI 53959-1936
- **Practice address phone:** (608) 768-6678
- **Practice address fax:** (608) 768-6681
- **Mailing address:** PO BOX 310, REEDSBURG, WI 53959-0310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 8793042 | WI | Yes |

## Other

- **Enumeration date:** 01/02/2008
- **Last updated:** 01/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5130389 | OTHER ID NUMBER | — |