Pca Corrections LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

60006494A Issued in IN

Legal business name

PCA CORRECTIONS LLC

Practice address

1740 Williamsburg Dr Ste a
Jeffersonville, IN 47130-8066

Phone

(502) 964-5359

NPI assigned

Sep 3, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Blacketer

Title

Managing Pharmacist

Phone

(502) 608-9183

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PCA Southern Indiana Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Pca-Corrections LLC

  • Long Term Care Pharmacy
  • Indianapolis, IN
  • NPI 1639608458

  O20201013002264

  Same enrollment

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442448000000",
    "number": "1962870295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 WILLIAMSBURG DR STE A",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471308066",
            "telephone_number": "502-964-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 WILLIAMSBURG DR STE A",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471308066",
            "telephone_number": "502-964-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCA CORRECTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-03",
        "last_updated": "2015-09-17",
        "status": "A",
        "authorized_official_last_name": "BLACKETER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING PHARMACIST",
        "authorized_official_telephone_number": "502-608-9183"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IN",
            "license": "60006494A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153835",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCA Southern Indiana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Long Term Care Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.