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
MR. STEVEN J DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
1049 SHOEMAKER ST STE 1, NANTY GLO, PA 15943-1248
(814) 419-6717
(814) 419-6719
Mailing address
1049 SHOEMAKER ST STE 1, NANTY GLO, PA 15943-1248
(814) 419-6717
(814) 419-6719
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
PA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102691494-0002
—
PA
Enumeration date
09/02/2014
Last updated
06/08/2022
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