MEDICARE: MAIN STREET DRUG INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1861275521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIN STREET DRUG INC

Provider Business Mailing Address
First Line	:	204 N MAIN ST
Second Line	:
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-2017
Country	:	US
Telephone Number	:	641-228-3519
Fax Number	:	641-228-3589

Provider Business Practice Location Address
First Line	:	204 N MAIN ST
Second Line	:
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-2017
Country	:	US
Telephone Number	:	641-228-3519
Fax Number	:	641-228-3589

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CYNTHIA SUE UETZ
Credential	:	PHARMD
Telephone Number	:	641-228-3519

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/16/2023

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Directions to “MAIN STREET DRUG INC ” Practice Location

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