Organization
MAINLINE PHARMACY EBENSBURG LLC
Active
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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