MEDICARE: PCA-CORRECTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	021700300	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2081076	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811183718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PCA-CORRECTIONS LLC

Provider Business Mailing Address
First Line	:	9818 WINDISCH RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3806
Country	:	US
Telephone Number	:	513-530-1636
Fax Number	:	513-530-1698

Provider Business Practice Location Address
First Line	:	9818 WINDISCH RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3806
Country	:	US
Telephone Number	:	513-530-1636
Fax Number	:	513-530-1698

Authorized Official
Title or Position	:	PIC
Name	:	DAVID WREN
Credential	:
Telephone Number	:	513-530-1636

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	07/09/2013

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