Provider Demographics
NPI:1962870295
Name:PCA CORRECTIONS LLC
Entity type:Organization
Organization Name:PCA CORRECTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-608-9183
Mailing Address - Street 1:1740 WILLIAMSBURG DR STE A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8066
Mailing Address - Country:US
Mailing Address - Phone:502-964-5359
Mailing Address - Fax:
Practice Address - Street 1:1740 WILLIAMSBURG DR STE A
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8066
Practice Address - Country:US
Practice Address - Phone:502-964-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006494A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153835OtherPK