Healthcare Provider Details

I. General information

NPI: 1508082140
Provider Name (Legal Business Name): 3JB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 BELLEMEADE DR
ALTOONA PA
16602-7402
US

IV. Provider business mailing address

1207 SECOND STREET
CRESSON PA
16630-1147
US

V. Phone/Fax

Practice location:
  • Phone: 814-944-9551
  • Fax: 814-944-8842
Mailing address:
  • Phone: 814-408-6800
  • Fax: 814-944-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413875L
License Number StatePA

VIII. Authorized Official

Name: STEVEN JOSEPH DECRISCIO
Title or Position: CFO
Credential:
Phone: 814-408-6800