Organization
PENINSULA PHARMACY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA DICKENS (BILLING MANAGER)
(757) 594-3944
Entity
Organization
Contact information
Practice address
11833 CANON BLVD, STE 114, NEWPORT NEWS, VA 23606-2589
(757) 594-3944
(757) 594-3950
Mailing address
11833 CANON BLVD, STE 114, NEWPORT NEWS, VA 23606-2589
(757) 594-3944
(757) 594-3950
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010143349
—
VA
Enumeration date
11/16/2006
Last updated
03/25/2009
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