Mainline Compounding & Infusion Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

PP482669 Issued in PA

Legal business name

MAINLINE COMPOUNDING & INFUSION PHARMACY LLC

Doing business as

Mainline Compounding & Infusion Pharmacy

Practice address

1049 Shoemaker St Ste 2
Nanty Glo, PA 15943-1248

Phone

(814) 419-5031

Fax

(814) 419-5041

NPI assigned

Aug 23, 2016

Organization subpart

No

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

Authorized official

Name

Jack Moschgat

Title

Pharmd

Phone

(814) 322-5055

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Mainline Compounding & Infusion Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488758400000",
    "number": "1235684952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 SHOEMAKER ST STE 2",
            "city": "NANTY GLO",
            "state": "PA",
            "postal_code": "159431248",
            "telephone_number": "814-419-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 SHOEMAKER ST STE 2",
            "city": "NANTY GLO",
            "state": "PA",
            "postal_code": "159431248",
            "telephone_number": "814-419-5031",
            "fax_number": "814-419-5041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE COMPOUNDING & INFUSION PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-23",
        "last_updated": "2017-03-06",
        "status": "A",
        "authorized_official_last_name": "MOSCHGAT",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "PHARMD",
        "authorized_official_telephone_number": "814-322-5055"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PA",
            "license": "PP482669",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166206",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103223817-0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mainline Compounding & Infusion Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Nanty Glo, PA
• Providers in Nanty Glo, PA by specialty
• Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2017; 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.