3JB LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PP413875L Issued in PA

Legal business name

3JB LLC

Doing business as

Mainline Pharmacy Altoona

Practice address

1667 Bellemeade Dr
Altoona, PA 16602-7402

Phone

(814) 944-9551

Fax

(814) 944-8842

NPI assigned

Apr 18, 2007

Last updated

Sep 21, 2022By the provider in NPPES

Organization subpart

No

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 1

Addresses

Other identifiers 1

Other names 1

• Mainline Pharmacy Altoona Doing business as

Locations

Practitioners 1

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.

• John W Jackson, RPH

  • Pharmacist
  • Altoona, PA
  • NPI 1275673451
  NPD (past)

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1508082140",
    "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": "166301147",
            "telephone_number": "814-408-6800",
            "fax_number": "814-944-8842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1667 BELLEMEADE DR",
            "city": "ALTOONA",
            "state": "PA",
            "postal_code": "166027402",
            "telephone_number": "814-944-9551",
            "fax_number": "814-944-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "3JB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP413875L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010672920002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mainline Pharmacy Altoona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Altoona, PA
• Providers in Altoona, PA by specialty
• Community/Retail Pharmacy in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.