Organization
MAINLINE CPL, LLC
Active
Other names
Mainline Pharmacy - Cresson
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN JOSEPH DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
1207 SECOND STREET, CRESSON, PA 16630-1147
(814) 886-5667
(814) 886-2203
Mailing address
1207 SECOND STREET, CRESSON, PA 16630-1147
(814) 886-5667
(814) 886-2203
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PP412243L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007331830003
—
PA
Enumeration date
10/12/2006
Last updated
04/21/2022
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