Organization
PCA CORRECTIONS LLC
Active
Other names
PCA Southern Indiana
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BLACKETER (MANAGING PHARMACIST)
(502) 608-9183
Entity
Organization
Contact information
Practice address
1740 WILLIAMSBURG DR STE A, JEFFERSONVILLE, IN 47130-8066
(502) 964-5359
Mailing address
1740 WILLIAMSBURG DR STE A, JEFFERSONVILLE, IN 47130-8066
(502) 964-5359
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
60006494A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153835
PK
—
Enumeration date
09/03/2015
Last updated
09/17/2015
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