Healthcare Provider Details

I. General information

NPI: 1811183718
Provider Name (Legal Business Name): PCA-CORRECTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9818 WINDISCH RD
WEST CHESTER OH
45069-3806
US

IV. Provider business mailing address

9818 WINDISCH RD
WEST CHESTER OH
45069-3806
US

V. Phone/Fax

Practice location:
  • Phone: 513-530-1636
  • Fax: 513-530-1698
Mailing address:
  • Phone: 513-530-1636
  • Fax: 513-530-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number021700300
License Number StateOH

VIII. Authorized Official

Name: DAVID WREN
Title or Position: PIC
Credential:
Phone: 513-530-1636