PENINSULA PHARMACY INC. (NPI# 1366943995) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366943995 |
| Entity Type | Organization |
| Organization Name | PENINSULA PHARMACY INC. |
| Other Organization Name | PENINSULA PHARMACY |
| Practice Address |
1414 W Fair Ave Ste 133 Marquette MI 49855-5408 |
| Practice Telephone | 9062253902 |
| Mailing Telephone | 9062253902 |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2018-02-28 |
| Authorized Official Name | TYLER J JENEMA (OWNER) |
| Authorized Official Telephone | 9062253902 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 3408990 | 05 |
| Other Name | Type Code |
|---|---|
| Peninsula Pharmacy | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | PENINSULA PHARMACY INC | 10419 95th Ave Fl 1, Ozone Park, Ny 11417 |
| Street Address |
1414 W FAIR AVE STE 133 |
| City | MARQUETTE |
| State | MI |
| Zip Code | 49855-5408 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417511981 | Gabrielle Smith | Pharmacy | 1414 W Fair Ave Ste 133, Marquette, MI 49855-5408 | 2019-04-30 |
| 1376020230 | Natalie L Smith | Pharmacist | 1414 W Fair Ave Ste 133, Marquette, MI 49855 | 2018-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023665064 | Scott Allen Poirier | Physician Assistant | 850 West Baraga Avenue, Marquette, MI 49855 | 2019-08-23 |
| 1730734831 | Katelyn Tourville | Physician Assistant | 1401 Presque Isle Ave-health Center, Marquette, MI 49855 | 2019-08-06 |
| 1932681095 | Katelyn Longanbach | Physical Therapist | 841 W Washington St Ste 500, Marquette, MI 49855 | 2018-09-05 |
| 1366943979 | Meijer, Inc. | Durable Medical Equipment & Medical Supplies | 3630 Us 41 W, Marquette, MI 49855 | 2018-02-28 |
| 1518466143 | Orthopaedic Surgery Associates of Marquette PC | Prosthetic/Orthotic Supplier | 841 West Washington Street, Suite 100, Marquette, MI 49855 | 2018-02-09 |
| 1376075598 | Pamela Baynton | Licensed Practical Nurse | 2292 U.S. 41 W, Marquette, MI 49855 | 2017-03-28 |
| 1548709454 | Allison Jean Czarny | Registered Nurse | 160 E Wright Pl, Marquette, MI 49855 | 2017-02-13 |
| 1629427299 | Larry Chappel | Social Worker | 210 Chippewa Square, Suite 208, Marquette, MI 49855 | 2016-06-06 |
| 1366898348 | Carla Pate | Student in an Organized Health Care Education/Training Program | 235 Hunt Hall, Marquette, MI 49855 | 2016-05-10 |
| 1922479732 | Nicholas Wujcik | Student in an Organized Health Care Education/Training Program | 504 S Fifth St, Marquette, MI 49855 | 2015-10-20 |
| Find all providers in zip 49855 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285604819 | State of Michigan Office of Financial Management | Pharmacy | 425 Fisher St, Marquette, MI 49855 | 2006-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437772159 | Krx Medication Consultants | Pharmacy | 8266 Fernwood St, Augusta, MI 49012 | 2020-05-28 |
| 1235751306 | Ypsilanti Family Pharmacy, Inc. | Pharmacy | 2287 Ellsworth Rd Ste A, Ypsilanti, MI 48197-4805 | 2020-05-12 |
| 1366082935 | Home Town Pharmacy Inc | Pharmacy | 1114 W South Airport Rd, Traverse City, MI 49686-4739 | 2020-01-13 |
| 1619510328 | Great Lakes Pharmacies I Inc | Pharmacy | 6213 Chicago Rd Ste 200, Warren, MI 48092-1697 | 2019-10-25 |
| 1710520143 | H & L Drugs Inc | Pharmacy | 1455 S Lapeer Rd Ste 101, Lake Orion, MI 48360-1468 | 2019-10-17 |
| 1225688229 | Guardian Pharmacy of Grand Rapids, LLC | Pharmacy | 2930 29th St Se, Grand Rapids, MI 49512-1723 | 2019-09-12 |
| 1457905259 | Senior Care Rx LLC | Pharmacy | 24293 Telegraph Rd Ste 130, Southfield, MI 48033-7924 | 2019-07-30 |
| 1063071637 | Smart Rx LLC | Pharmacy | 25464 Van Born Rd, Dearborn Heights, MI 48125 | 2019-06-07 |
| 1457812117 | Pharmtek LLC | Pharmacy | 3307 Orchard Lake Rd, Keego Harbor, MI 48320-1308 | 2019-03-26 |
| 1801350772 | Prestige Specialty Pharmacy 2 | Pharmacy | 31700 Van Dyke Ave Ste B, Warren, MI 48093-7949 | 2019-01-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.