Provider Demographics
NPI:1225142318
Name:3JB LLC
Entity Type:Organization
Organization Name:3JB LLC
Other - Org Name:MAINLINE PHARMACY - DAVIDSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DECRISCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-408-6800
Mailing Address - Street 1:118 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DAVIDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15928
Mailing Address - Country:US
Mailing Address - Phone:814-479-2588
Mailing Address - Fax:814-479-2031
Practice Address - Street 1:118 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:DAVIDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15928
Practice Address - Country:US
Practice Address - Phone:814-479-2588
Practice Address - Fax:814-479-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP411037L3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPP411037LOtherPA SBOP LICENSE
PA103037188-0003Medicaid
2084278OtherPK