NPIMap

Organization Active NPI

Peninsula Pharmacies Inc

  • Community/Retail Pharmacy
  • Long Beach, WA
National Provider Identifier
1275615106
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
CF00000497 Issued in WA
Legal business name
PENINSULA PHARMACIES INC
Practice address
101 Bolstad Ave
Long Beach, WA 98631
Phone
(360) 642-2349
Fax
(360) 642-8786
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Authorized official

Name
Jeffrey Shane Harrell
Title
President
Phone
(360) 244-5984

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X CF00000497 WA Primary

Addresses

Primary practice location

101 Bolstad Ave
Long Beach, WA 98631

Mailing address

PO Box 187
101 Bolstad Ave
Long Beach, WA 98631
Phone (360) 642-2349

Other identifiers 1

IdentifierTypeStateIssuer
6085609MedicaidWA

Other names 1

  • Long Beach Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Pharmacies Inc Long Beach Pharmacy Annex5 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 6

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": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652313600000",
    "number": "1275615106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 187",
            "address_2": "101 BOLSTAD AVE",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "98631",
            "telephone_number": "360-642-2349",
            "fax_number": "360-642-8786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BOLSTAD AVE",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "98631",
            "telephone_number": "360-642-2349",
            "fax_number": "360-642-8786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PHARMACIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "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": "360-244-5984"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00000497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6085609",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Long Beach Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Long Beach Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; 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.