Organization
PENINSULA PHARMACY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE BOGGS (ADMINISTRATOR)
(757) 594-4600
Entity
Organization
Contact information
Practice address
11833 CANON BLVD, STE 114, NEWPORT NEWS, VA 23606-2589
(757) 594-3944
(757) 594-3950
Mailing address
608 DENBIGH BLVD, STE 800, NEWPORT NEWS, VA 23608-4410
(757) 875-7545
(757) 875-7553
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
0201003424
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101131189
—
VA
01
—
010143349
MEDICAID (DME)
VA
01
—
173212
ANTHEM
VA
Enumeration date
10/11/2005
Last updated
01/22/2009
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