NPIMap

Organization Active NPI

Peninsula Pharmacy Inc

  • Home Infusion Agency
  • Marquette, MI
National Provider Identifier
1679618474
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion AgencyTaxonomy code 251F00000X
License
5301006679 Issued in MI
Legal business name
PENINSULA PHARMACY INC
Practice address
1414 W Fair Ave
Suite 133
Marquette, MI 49855-2675
Phone
(906) 225-3902
Fax
(906) 226-2661
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Authorized official

Name
Kent L Jenema, R.PH.
Title
Director of Pharmacy Operations
Phone
(906) 225-3902

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X 5301006679 MI Primary

Addresses

Primary practice location

1414 W Fair Ave
Suite 133
Marquette, MI 49855-2675

Mailing address

1414 W Fair Ave
Suite 133
Marquette, MI 49855-2675
Phone (906) 225-3902

Other identifiers 1

IdentifierTypeStateIssuer
470E21056OtherMIBCBS-MI HIT

Other names 1

  • PENINSULA PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1679618474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE",
            "address_2": "SUITE 133",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552675",
            "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": "1414 W FAIR AVE",
            "address_2": "SUITE 133",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552675",
            "telephone_number": "906-225-3902",
            "fax_number": "906-226-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "JENEMA",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY OPERATIONS",
        "authorized_official_telephone_number": "906-225-3902",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "MI",
            "license": "5301006679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-MI HIT",
            "identifier": "470E21056",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PENINSULA PHARMACY",
            "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 Nov 16, 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.