Active NPI
Mainline Pharmacy Ebensburg, LLC
- Community/Retail Pharmacy
- Nanty Glo, PA
National Provider Identifier
1235539800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- MAINLINE PHARMACY EBENSBURG, LLC
- Doing business as
- Mainline Pharmacy
- Practice address
- 1049 Shoemaker St Ste 1
Nanty Glo, PA 15943-1248 - Phone
- (814) 419-6717
- Fax
- (814) 419-6719
- NPI assigned
- Sep 2, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Steven J Decriscio
- Title
- Cfo
- Phone
- (814) 408-6800
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | PA | ||
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
1049 Shoemaker St Ste 1
Nanty Glo, PA 15943-1248
Mailing address
1049 Shoemaker St Ste 1
Nanty Glo, PA 15943-1248
Phone (814) 419-6717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102691494-0002 | Medicaid | PA |
Other names 1
- Mainline Pharmacy
National Provider Directory
National Provider DirectoryLocations
1049 Shoemaker St
Ste 1
Nanty Glo, PA 15943
Phone (814) 419-6717
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Portage, PA
- NPI 1154650851
-
- Pharmacist
- Nanty Glo, PA
- NPI 1124673496
-
- Pharmacist
- Blairsville, PA
- NPI 1801227186
Addiction (Substance Use Disorder)
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409616000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1654646400000",
"number": "1235539800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1049 SHOEMAKER ST STE 1",
"city": "NANTY GLO",
"state": "PA",
"postal_code": "159431248",
"telephone_number": "814-419-6717",
"fax_number": "814-419-6719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1049 SHOEMAKER ST STE 1",
"city": "NANTY GLO",
"state": "PA",
"postal_code": "159431248",
"telephone_number": "814-419-6717",
"fax_number": "814-419-6719"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAINLINE PHARMACY EBENSBURG, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-09-02",
"last_updated": "2022-06-08",
"certification_date": "2022-06-08",
"status": "A",
"authorized_official_last_name": "DECRISCIO",
"authorized_official_first_name": "STEVEN",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "814-408-6800",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "PA",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102691494-0002",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mainline Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Nanty Glo, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.