Organization
3JB LLC
Active
Other names
Mainline Pharmacy - Somerset
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN JOSEPH DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
168 W MAIN ST, SOMERSET, PA 15501-2038
(814) 445-6511
(814) 445-5908
Mailing address
168 W MAIN ST, SOMERSET, PA 15501-2038
(814) 445-6511
(814) 445-5908
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP412340L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103037188-0002
—
PA
01
—
3900164
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/01/2006
Last updated
06/08/2022
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