Healthcare Provider Details

I. General information

NPI: 1780600114
Provider Name (Legal Business Name): 3JB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E MARKET ST
BLAIRSVILLE PA
15717-1122
US

IV. Provider business mailing address

315 E MARKET ST
BLAIRSVILLE PA
15717-1122
US

V. Phone/Fax

Practice location:
  • Phone: 724-459-7400
  • Fax: 724-459-8207
Mailing address:
  • Phone: 724-459-7400
  • Fax: 724-459-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412331L
License Number StatePA

VIII. Authorized Official

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