Peninsula Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY36626 Issued in CA

Legal business name

PENINSULA PHARMACY

Doing business as

PENINSULA PHARMACY

Practice address

1294 W 6TH St Ste 100
San Pedro, CA 90731-2997

Phone

(310) 833-3535

Fax

(310) 833-9124

NPI assigned

Jun 14, 2006

Organization subpart

No

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

Authorized official

Name

Shahram Elie, RPH

Title

President

Phone

(310) 833-3535

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PENINSULA PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1710920079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1294 W 6TH ST STE 100",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "90731",
            "telephone_number": "310-833-3535",
            "fax_number": "310-833-9124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1294 W 6TH ST STE 100",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312997",
            "telephone_number": "310-833-3535",
            "fax_number": "310-833-9124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "ELIE",
        "authorized_official_first_name": "SHAHRAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-833-3535",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY36626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA3662460",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1993007",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PENINSULA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle L Penfold
• Hsiao P Peng, D.D.S.
• Peninsula Anesthesia Group, Inc.
• Peninsula Eyecare Medical Associates
• Peninsula Outpatient Surgery Center, Inc.
• Vicki Penny, NP
• Blair Phillip Peoples, M.D.
• Adrienne Peralta, SUD COUNSELOR
• Ellaine Peralta
• Josue Pereira

• Community/Retail Pharmacy in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.