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General NPI Number Information
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NPI Number | 1962870295
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Entity Type | Organization
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Legal Business Name | PCA CORRECTIONS LLC
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 1740 WILLIAMSBURG DR STE A
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-8066
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Country | US
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Telephone | 502-964-5359
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 WILLIAMSBURG DR STE A
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-8066
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Country | US
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Telephone | 502-964-5359
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Fax |
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Authorized Official
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Title or Position | MANAGING PHARMACIST
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Name | MICHAEL BLACKETER
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Credential |
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Telephone | 502-608-9183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 60006494A
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License Number State | IN
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