Provider Demographics
NPI:1205828746
Name:PSI, LLC
Entity Type:Organization
Organization Name:PSI, LLC
Other - Org Name:ELDERCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSTY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-783-1515
Mailing Address - Street 1:4315 BELAIR FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9412
Mailing Address - Country:US
Mailing Address - Phone:888-858-6051
Mailing Address - Fax:888-858-6052
Practice Address - Street 1:4315 BELAIR FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9412
Practice Address - Country:US
Practice Address - Phone:888-858-6051
Practice Address - Fax:888-858-6052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1146415OtherNCPDP
GA00835942AMedicaid
GA00835942AMedicaid