Peninsula Advanced Care Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PENINSULA ADVANCED CARE PHARMACY LLC

Practice address

850 W Baraga Avenue
1St Floor, Room 1178
Marquette, MI 49855

Phone

(906) 225-3902

NPI assigned

Dec 8, 2023

Last updated

Dec 8, 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) 869-0999

Specialties & licenses 3

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": "1701993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1972370013",
    "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": "850 W BARAGA AVENUE",
            "address_2": "1ST FLOOR, ROOM 1178",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "49855",
            "telephone_number": "906-225-3902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA ADVANCED CARE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-08",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "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": "906-869-0999",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Marquette, MI
• Providers in Marquette, 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 Dec 8, 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.