Peninsula Professional Center Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

License

PHY17946 Issued in CA

Legal business name

PENINSULA PROFESSIONAL CENTER PHARMACY

Practice address

1828 El Camino Real
Peninsula Professional Center Pharmacy
Burlingame, CA 94010-3103

Phone

(650) 692-3977

Fax

(650) 692-3978

NPI assigned

Dec 9, 2005

Organization subpart

No

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

Authorized official

Name

Dr. George A Poole, PHARM D

Title

Owner

Phone

(650) 692-3977

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891770038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 EL CAMINO REAL",
            "address_2": "PENINSULA PROFESSIONAL CENTER PHARMACY",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940103103",
            "telephone_number": "650-692-3977",
            "fax_number": "650-692-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1828 EL CAMINO REAL",
            "address_2": "PENINSULA PROFESSIONAL CENTER PHARMACY",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940103103",
            "telephone_number": "650-692-3977",
            "fax_number": "650-692-3978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PROFESSIONAL CENTER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-692-3977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY17946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Burlingame, CA
• Providers in Burlingame, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.