Organization
3JB LLC
Active
Other names
Mainline Pharmacy - Davidsville
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN J DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
118 N MAIN STREET, DAVIDSVILLE, PA 15928
(814) 479-2588
(814) 479-2031
Mailing address
118 N MAIN STREET, DAVIDSVILLE, PA 15928
(814) 479-2588
(814) 479-2031
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP411037L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103037188-0003
—
PA
01
—
PP411037L
PA SBOP LICENSE
PA
Enumeration date
08/18/2006
Last updated
06/08/2022
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