Reliable Pharmacy of Wisconsin LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

9488-42 Issued in WI

Legal business name

RELIABLE PHARMACY OF WISCONSIN LLC

Doing business as

Reliable Pharmacy of Wisconsin

Practice address

10105 74TH St Ste 102
Kenosha, WI 53142-7519

Phone

(262) 909-5685

Fax

(262) 925-8409

NPI assigned

Nov 22, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cynthia Cernak

Title

Owner

Phone

(262) 565-6353

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Reliable Pharmacy of Wisconsin Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1336653674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10105 74TH ST",
            "address_2": "SUITE 102",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427519",
            "telephone_number": "262-909-5685",
            "fax_number": "262-925-8409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10105 74TH ST STE 102",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427519",
            "telephone_number": "262-909-5685",
            "fax_number": "262-925-8409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELIABLE PHARMACY OF WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-22",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "CERNAK",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-565-6353"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9488-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2172877",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100073905",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reliable Pharmacy of Wisconsin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sarah Rens, PA-C

• Community/Retail Pharmacy in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.