Peninsula Pharmacy Gladstone LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PENINSULA PHARMACY GLADSTONE LLC

Practice address

117 N 9TH St
Gladstone, MI 49837-1644

Phone

(906) 225-3902

Fax

(906) 226-2661

NPI assigned

Jun 13, 2023

Last updated

Jun 15, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tyler J Jenema, PHARM.D.NPI 1326375262

Title

Pharmacist

Phone

(906) 225-3902

Specialties & licenses 1

Addresses

Locations

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.

• Tyler J Jenema, PHARM.D.

  • Pharmacist
  • Marquette, MI
  • NPI 1326375262
  Authorized official Same address or phone

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

{
    "created_epoch": "1686614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1215611959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE STE 133",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498555408",
            "telephone_number": "906-225-3902",
            "fax_number": "906-226-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 N 9TH ST",
            "city": "GLADSTONE",
            "state": "MI",
            "postal_code": "498371644",
            "telephone_number": "906-225-3902",
            "fax_number": "906-226-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PHARMACY GLADSTONE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-13",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "JENEMA",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "906-225-3902",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Murrays Country View
• Northwoods Rehabilitation Inc.
• Carley O'Neal, DPT, PT
• Charles S Olsen, DO
• Jenilee Pellegrini
• Richard Charles Pfotenhauer, D.D.S., P.C.
• Scott A Randall, M.D.
• Matthew Rayeski, DO
• Erik M Rubright, DO
• Joann Leano Santos

• Community/Retail Pharmacy in Gladstone, MI
• Providers in Gladstone, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.