NPIMap

Organization Active NPI

Peninsula Pharmacy Plus LLC

  • Community/Retail Pharmacy
  • Marquette, MI
National Provider Identifier
1144646290
Registry record updated Feb 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301010508 Issued in MI
Legal business name
PENINSULA PHARMACY PLUS LLC
Practice address
300 N McClellan Ave
Marquette, MI 49855-3920
Phone
(906) 225-1450
Fax
(906) 225-1501
NPI assigned
Mar 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2020

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

Authorized official

Name
Dr. Tyler J Jenema, PHARM.D.NPI 1326375262
Title
President
Phone
(906) 225-1450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301010508 MI Primary

Addresses

Primary practice location

300 N McClellan Ave
Marquette, MI 49855-3920

Mailing address

300 N McClellan Ave
Marquette, MI 49855-3920
Phone (906) 225-1450

Other names 1

  • Peninsula Pharmacy Plus Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581897600000",
    "number": "1144646290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N MCCLELLAN AVE",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498553920",
            "telephone_number": "906-225-1450",
            "fax_number": "906-225-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N MCCLELLAN AVE",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498553920",
            "telephone_number": "906-225-1450",
            "fax_number": "906-225-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PHARMACY PLUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-13",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A",
        "authorized_official_last_name": "JENEMA",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "906-225-1450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peninsula Pharmacy Plus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marquette, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.