# PENINSULA PHARMACY INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peninsula Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366943995
- **Authorized official:** PRAVEEN J CHALLA PHARMD (OWNER)
- **Authorized official phone:** (906) 225-3902

## Contact information

- **Practice address:** 1414 W FAIR AVE STE 133, MARQUETTE, MI 49855-5408
- **Practice address phone:** (906) 225-3902
- **Mailing address:** 1414 W FAIR AVE STE 133, MARQUETTE, MI 49855-5408
- **Mailing address phone:** (906) 225-3902

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 02/28/2018
- **Last updated:** 12/18/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3408990 | — | MI |