NPIMap

Organization Active NPI

Peninsula Pharmacies Inc.

Doing business as Ilwaco Pharmacy

  • Long Term Care Pharmacy
  • Ilwaco, WA
National Provider Identifier
1104423870
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
PENINSULA PHARMACIES INC.
Doing business as
Ilwaco Pharmacy
Practice address
101 1St Ave S
Ilwaco, WA 98624-9100
Phone
(360) 642-3133
Fax
(360) 642-5133
NPI assigned
Oct 6, 2020
Last updated
Dec 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Shane HarrellNPI 1689756660
Title
President
Phone
(360) 642-3133

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

101 1St Ave S
Ilwaco, WA 98624-9100

Mailing address

PO Box B
Ilwaco, WA 98624-0167
Phone (360) 642-3133

Other names 1

  • Ilwaco Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Pharmacies in5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1104423870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX B",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240167",
            "telephone_number": "360-642-3133",
            "fax_number": "360-642-5133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 1ST AVE S",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986249100",
            "telephone_number": "360-642-3133",
            "fax_number": "360-642-5133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PHARMACIES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-642-3133"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ilwaco Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ilwaco Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ilwaco, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.