Organization
3JB LLC
Active
Other names
Mainline Pharmacy Altoona
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN JOSEPH DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
1667 BELLEMEADE DR, ALTOONA, PA 16602-7402
(814) 944-9551
(814) 944-8842
Mailing address
1207 SECOND STREET, CRESSON, PA 16630-1147
(814) 408-6800
(814) 944-8842
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP413875L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010672920002
—
PA
Enumeration date
04/18/2007
Last updated
09/21/2022
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