| NPI | 1003807413 |
|---|---|
| Doing Business As | PENINSULA PHARMACY |
| Entity Type | Organization |
| Authorized Contact | PRAVEEN CHALLA President 906-225-3902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301010345) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5301010345) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 1199700001) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: MI 1003807413) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: MI 5301010345) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2024-12-18 |