Healthcare Provider Details

I. General information

NPI: 1326106444
Provider Name (Legal Business Name): MAINLINE PHARMACY MURRYSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 OLD WILLIAM PENN HWY
MURRYSVILLE PA
15668-1833
US

IV. Provider business mailing address

3907 OLD WILLIAM PENN HWY
MURRYSVILLE PA
15668-1833
US

V. Phone/Fax

Practice location:
  • Phone: 724-327-6611
  • Fax: 724-327-5814
Mailing address:
  • Phone: 724-327-6611
  • Fax: 724-327-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP410755L
License Number StatePA

VIII. Authorized Official

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