Organization
MAIN STREET PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY KISSACK RPH (OWNER)
(608) 524-1616
Entity
Organization
Contact information
Practice address
140 E MAIN ST, REEDSBURG, WI 53959-1936
(608) 768-6678
(608) 768-6681
Mailing address
PO BOX 310, REEDSBURG, WI 53959-0310
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
8793042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5130389
OTHER ID NUMBER
—
Enumeration date
01/02/2008
Last updated
01/02/2008
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