Organization
MAINLINE COMPOUNDING & INFUSION PHARMACY LLC
Active
Other names
Mainline Compounding & Infusion Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JACK MOSCHGAT (PHARMD)
(814) 322-5055
Entity
Organization
Contact information
Practice address
1049 SHOEMAKER ST STE 2, NANTY GLO, PA 15943-1248
(814) 419-5031
(814) 419-5041
Mailing address
1049 SHOEMAKER ST STE 2, NANTY GLO, PA 15943-1248
(814) 419-5031
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PP482669
PA
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103223817-0001
—
PA
01
—
2166206
PK
—
Enumeration date
08/23/2016
Last updated
03/06/2017
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