Healthcare Provider Details

I. General information

NPI: 1811992001
Provider Name (Legal Business Name): 3JB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 ROUTE 130
HARRISON CITY PA
15636-1516
US

IV. Provider business mailing address

1207 SECOND STREET
CRESSON PA
16630-1147
US

V. Phone/Fax

Practice location:
  • Phone: 724-744-3300
  • Fax: 724-744-2351
Mailing address:
  • Phone: 721-744-3300
  • Fax: 724-744-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP412338L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN J DECRISCIO
Title or Position: CFO
Credential:
Phone: 814-408-6800