Provider Demographics
NPI:1639608458
Name:PCA-CORRECTIONS LLC
Entity Type:Organization
Organization Name:PCA-CORRECTIONS LLC
Other - Org Name:PCA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAPATSARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-266-2523
Mailing Address - Street 1:7172 LAKEVIEW PARKWAY WEST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4104
Mailing Address - Country:US
Mailing Address - Phone:800-445-8917
Mailing Address - Fax:800-445-8918
Practice Address - Street 1:7172 LAKEVIEW PARKWAY WEST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4104
Practice Address - Country:US
Practice Address - Phone:800-445-8917
Practice Address - Fax:800-445-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
IN60006609A3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169267OtherPK