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General NPI Number Information
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NPI Number | 1326106444
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Entity Type | Organization
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Legal Business Name | MAINLINE PHARMACY MURRYSVILLE, LLC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 3907 OLD WILLIAM PENN HWY
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City | MURRYSVILLE
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State | PA
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Zip | 15668-1833
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Country | US
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Telephone | 724-327-6611
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Fax | 724-327-5814
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Provider Business Mailing Address
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Address Line | 3907 OLD WILLIAM PENN HWY
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City | MURRYSVILLE
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State | PA
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Zip | 15668-1833
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Country | US
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Telephone | 724-327-6611
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Fax | 724-327-5814
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Authorized Official
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Title or Position | CFO
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Name | STEVEN JOSEPH DECRISCIO
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Credential |
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Telephone | 814-408-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP410755L
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License Number State | PA
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