Organization
3JB LLC
Active
Other names
Mainline Pharmacy - Blairsville
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN JOSEPH DECRISCIO (CFO)
(814) 408-6800
Entity
Organization
Contact information
Practice address
315 E MARKET ST, BLAIRSVILLE, PA 15717-1122
(724) 459-7400
(724) 459-8207
Mailing address
315 E MARKET ST, BLAIRSVILLE, PA 15717-1122
(724) 459-7400
(724) 459-8207
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP412331L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0178510001
PTAN/NSC
—
05
—
1030371880001
—
PA
01
—
2154605
PK
—
01
—
7478670001
PTAN/NSC
—
Enumeration date
07/15/2006
Last updated
09/28/2022
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