Provider Demographics
NPI:1861565582
Name:3JB LLC
Entity type:Organization
Organization Name:3JB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DECRISCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-408-6800
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16646-0598
Mailing Address - Country:US
Mailing Address - Phone:814-247-9959
Mailing Address - Fax:814-274-8690
Practice Address - Street 1:317 BEAVER ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:PA
Practice Address - Zip Code:16646-0520
Practice Address - Country:US
Practice Address - Phone:814-247-9959
Practice Address - Fax:814-247-8690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP411885L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103037188-0005Medicaid
PA0007854720001Medicaid
PA0007854720001Medicaid