Organization
MAINLINE PHARMACY EBENSBURG LLC
Active
Other names
Mainline Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN JOSEPH DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
3720 NEW GERMANY RD, EBENSBURG, PA 15931-1862
(814) 472-9390
(814) 472-1166
Mailing address
1207 SECOND STREET, CRESSON, PA 16630-0058
(814) 408-6800
(814) 886-2203
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
PA
174H00000X
Health Educator
—
PA
3336C0003X
Community/Retail Pharmacy
Primary
PP412694L
PA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026914940003
—
PA
01
—
2133430
PK
—
Enumeration date
12/22/2011
Last updated
04/26/2022
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