# MAINLINE CPL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MAINLINE LTC PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124352760
- **Authorized official:** MR. STEVEN JOSEPH DECRISCIO (CFO)
- **Authorized official phone:** (814) 408-6800

## Contact information

- **Practice address:** 1049 SHOEMAKER ST STE 2, NANTY GLO, PA 15943-1248
- **Practice address phone:** (814) 736-3044
- **Practice address fax:** (814) 736-9522
- **Mailing address:** 1049 SHOEMAKER ST STE 2, NANTY GLO, PA 15943-1248
- **Mailing address phone:** (814) 736-3044
- **Mailing address fax:** (814) 736-9522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | PP481858 | PA | Yes |

## Other

- **Enumeration date:** 09/30/2009
- **Last updated:** 04/27/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | PP481858 | PA STATE LICENSE | PA |