Healthcare Provider Details

I. General information

NPI: 1598771263
Provider Name (Legal Business Name): 3JB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 W MAIN ST
SOMERSET PA
15501-2038
US

IV. Provider business mailing address

168 W MAIN ST
SOMERSET PA
15501-2038
US

V. Phone/Fax

Practice location:
  • Phone: 814-445-6511
  • Fax: 814-445-5908
Mailing address:
  • Phone: 814-445-6511
  • Fax: 814-445-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412340L
License Number StatePA

VIII. Authorized Official

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