Provider Demographics
NPI:1801209804
Name:PSI, LLC
Entity Type:Organization
Organization Name:PSI, LLC
Other - Org Name:ELDERCARE PHARMACY ROYSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-783-1515
Mailing Address - Street 1:635 COOK ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-3932
Mailing Address - Country:US
Mailing Address - Phone:762-847-7403
Mailing Address - Fax:706-245-1421
Practice Address - Street 1:635 COOK ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3932
Practice Address - Country:US
Practice Address - Phone:762-847-7403
Practice Address - Fax:706-245-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
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
GA003148860AMedicaid