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General NPI Number Information
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NPI Number | 1780964650
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Entity Type | Organization
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Legal Business Name | MAINLINE RESOURCES LLC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 1876 CRAIGSHIRE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4006
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Country | US
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Telephone | 231-775-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 22411 130TH AVE
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City | TUSTIN
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State | MI
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Zip | 49688-8565
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Country | US
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Telephone | 231-775-7141
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DOUGLAS DEVRIES
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Credential |
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Telephone | 231-775-7141
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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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