Organization
PENINSULA PHARMACY INC.
Active
Other names
Peninsula Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVEEN J CHALLA PHARMD (OWNER)
(906) 225-3902
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE STE 133, MARQUETTE, MI 49855-5408
(906) 225-3902
Mailing address
1414 W FAIR AVE STE 133, MARQUETTE, MI 49855-5408
(906) 225-3902
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408990
—
MI
Enumeration date
02/28/2018
Last updated
12/18/2024
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