Organization
RELIABLE PHARMACY OF WISCONSIN LLC
Active
Other names
Reliable Pharmacy of Wisconsin
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA CERNAK (OWNER)
(262) 565-6353
Entity
Organization
Contact information
Practice address
10105 74TH ST STE 102, KENOSHA, WI 53142-7519
(262) 909-5685
(262) 925-8409
Mailing address
10105 74TH ST, SUITE 102, KENOSHA, WI 53142-7519
(262) 909-5685
(262) 925-8409
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9488-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100073905
—
WI
01
—
2172877
PK
—
Enumeration date
11/22/2017
Last updated
07/19/2018
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