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General NPI Number Information
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NPI Number | 1235684952
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Entity Type | Organization
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Legal Business Name | MAINLINE COMPOUNDING & INFUSION PHARMACY LLC
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 1049 SHOEMAKER ST STE 2
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City | NANTY GLO
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State | PA
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Zip | 15943-1248
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Country | US
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Telephone | 814-419-5031
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Fax | 814-419-5041
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Provider Business Mailing Address
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Address Line | 1049 SHOEMAKER ST STE 2
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City | NANTY GLO
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State | PA
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Zip | 15943-1248
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Country | US
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Telephone | 814-419-5031
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Fax |
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Authorized Official
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Title or Position | PHARMD
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Name | JACK MOSCHGAT
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Credential |
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Telephone | 814-322-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PP482669
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License Number State | PA
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