Organization
PENINSULA PHARMACY INC
Active
Other names
PENINSULA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KENT L JENEMA R.PH. (DIRECTOR OF PHARMACY OPERATIONS)
(906) 225-3902
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE, SUITE 133, MARQUETTE, MI 49855-2675
(906) 225-3902
(906) 226-2661
Mailing address
1414 W FAIR AVE, SUITE 133, MARQUETTE, MI 49855-2675
(906) 225-3902
(906) 226-2661
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
5301006679
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
470E21056
BCBS-MI HIT
MI
Enumeration date
02/20/2007
Last updated
11/16/2022
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