Healthcare Provider Details

I. General information

NPI: 1861565582
Provider Name (Legal Business Name): 3JB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 BEAVER ST
HASTINGS PA
16646-0520
US

IV. Provider business mailing address

PO BOX 598
HASTINGS PA
16646-0598
US

V. Phone/Fax

Practice location:
  • Phone: 814-247-9959
  • Fax: 814-247-8690
Mailing address:
  • Phone: 814-247-9959
  • Fax: 814-274-8690

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 NumberPP411885L
License Number StatePA

VIII. Authorized Official

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