Organization
MAINLINE CPL, LLC
Active
Other names
Mainline Pharmacy Portage
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN JOSEPH DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
619 MAIN ST, PORTAGE, PA 15946-1539
(814) 736-4530
(814) 736-9522
Mailing address
619 MAIN ST, PORTAGE, PA 15946-1539
(814) 736-4530
(814) 736-9522
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PP413275L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007331830002
—
PA
Enumeration date
01/23/2007
Last updated
04/27/2022
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