Active NPI
3JB LLC
- Community/Retail Pharmacy
- Harrison City, PA
National Provider Identifier
1811992001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- 3JB LLC
- Practice address
- 2106 Route 130
Harrison City, PA 15636-1516 - Phone
- (724) 744-3300
- Fax
- (724) 744-2351
- NPI assigned
- Jun 15, 2005
- 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 | PP412338L | PA | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
2106 Route 130
Harrison City, PA 15636-1516
Mailing address
1207 Second Street
Cresson, PA 16630-1147
Phone (721) 744-3300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103037188-0004 | Medicaid | PA |
Other names 1
- Mainline Pharmacy Harrison City
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170815000999 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 5294031670 |
4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Somerset, PA |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
2106 Route 130
Harrison City, PA 15636
Phone (724) 744-3300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118793600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1654646400000",
"number": "1811992001",
"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": "721-744-3300",
"fax_number": "724-744-2351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2106 ROUTE 130",
"city": "HARRISON CITY",
"state": "PA",
"postal_code": "156361516",
"telephone_number": "724-744-3300",
"fax_number": "724-744-2351"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "3JB LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-06-15",
"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": "PP412338L",
"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": "103037188-0004",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mainline Pharmacy Harrison City",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Harrison City, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.