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NPI Code Detail

MEDICARE: MAINLINE PHARMACY EBENSBURG LLC

MEDICARE: MAINLINE PHARMACY EBENSBURG LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorPA
2174H00000XHealth EducatorPA
33336C0003XCommunity/Retail Pharmacy
43336C0003XCommunity/Retail PharmacyPP412694LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22133430OTHERPK

General Provider Information

NPI Number : 1184993040
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAINLINE PHARMACY EBENSBURG LLC
Provider Business Mailing Address
First Line : 1207 SECOND STREET
Second Line :
City : CRESSON
State : PA
Zip : 16630-0058
Country : US
Telephone Number : 814-408-6800
Fax Number : 814-886-2203
Provider Business Practice Location Address
First Line : 3720 NEW GERMANY RD
Second Line :
City : EBENSBURG
State : PA
Zip : 15931-1862
Country : US
Telephone Number : 814-472-9390
Fax Number : 814-472-1166
Authorized Official
Title or Position : CFO
Name : STEVEN JOSEPH DECRISCIO
Credential :
Telephone Number : 814-408-6800
Provider Enumeration Date : 12/22/2011
Last Update Date : 04/26/2022

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Directions to “MAINLINE PHARMACY EBENSBURG LLC ” Practice Location

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