Provider Demographics
NPI:1750920088
Name:MAIN STREET DRUG
Entity type:Organization
Organization Name:MAIN STREET DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:UETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:641-228-3519
Mailing Address - Street 1:204 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-2017
Mailing Address - Country:US
Mailing Address - Phone:641-228-3519
Mailing Address - Fax:641-228-3589
Practice Address - Street 1:204 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-2017
Practice Address - Country:US
Practice Address - Phone:641-330-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies