NPIMap

Organization Active NPI

Mainline Pharmacy Ebensburg LLC

Doing business as Mainline Pharmacy

  • Community/Retail Pharmacy
  • Ebensburg, PA
National Provider Identifier
1184993040
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP412694L Issued in PA
Legal business name
MAINLINE PHARMACY EBENSBURG LLC
Doing business as
Mainline Pharmacy
Practice address
3720 New Germany Rd
Ebensburg, PA 15931-1862
Phone
(814) 472-9390
Fax
(814) 472-1166
NPI assigned
Dec 22, 2011
Last updated
Apr 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven Joseph Decriscio
Title
Cfo
Phone
(814) 408-6800

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X PA
Community/Retail Pharmacy 3336C0003X
Community/Retail Pharmacy 3336C0003X PP412694L PA Primary
Health Educator 174H00000X PA

Addresses

Primary practice location

3720 New Germany Rd
Ebensburg, PA 15931-1862

Mailing address

1207 Second Street
Cresson, PA 16630-0058
Phone (814) 408-6800

Other identifiers 2

IdentifierTypeStateIssuer
1026914940003MedicaidPA
2133430OtherPK

Other names 1

  • Mainline Pharmacy Doing business as

National Provider Directory

National Provider Directory

Locations

1104 W High St
Ste 1
Ebensburg, PA 15931
Phone (814) 472-9390

3720 New Germany Rd
Ebensburg, PA 15931
Phone (814) 472-9390

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650931200000",
    "number": "1184993040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 SECOND STREET",
            "city": "CRESSON",
            "state": "PA",
            "postal_code": "166300058",
            "telephone_number": "814-408-6800",
            "fax_number": "814-886-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3720 NEW GERMANY RD",
            "city": "EBENSBURG",
            "state": "PA",
            "postal_code": "159311862",
            "telephone_number": "814-472-9390",
            "fax_number": "814-472-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE PHARMACY EBENSBURG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-22",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A",
        "authorized_official_last_name": "DECRISCIO",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "814-408-6800"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP412694L",
            "primary": true
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026914940003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133430",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mainline Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mainline Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ebensburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.