Organization
MAINLINE CPL, LLC
Active
Other names
MAINLINE LTC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN JOSEPH DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
1049 SHOEMAKER ST STE 2, NANTY GLO, PA 15943-1248
(814) 736-3044
(814) 736-9522
Mailing address
1049 SHOEMAKER ST STE 2, NANTY GLO, PA 15943-1248
(814) 736-3044
(814) 736-9522
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PP481858
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PP481858
PA STATE LICENSE
PA
Enumeration date
09/30/2009
Last updated
04/27/2022
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