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PENINSULA PHARMACY NPI 1710920079


NPI Information

NPI: 1710920079
Provider Name: PENINSULA PHARMACY

Doing Business As: PENINSULA PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
1294 W 6TH ST STE 100
SAN PEDRO, CA
ZIP 90731
Phone: (310) 833-3535
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PENINSULA PHARMACY is a community/retail pharmacy pharmacy in San Pedro, CA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. PENINSULA PHARMACY NPI is 1710920079. The provider is registered as an organization entity type.
The provider Is Doing Business As Peninsula Pharmacy.

The provider's business location address is:

1294 W 6TH ST STE 100
SAN PEDRO, CA
ZIP 90731-997
Phone: (310) 833-3535
Fax: (310) 833-9124

The provider's authorized official is Shahram Elie .
The authorized official title is President and has the following contact phone number (310) 833-3535.

The enumeration date for this NPI number is 6/14/2006 and was last updated on 7/19/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacyNo
23336C0003XPharmacyCommunity/Retail PharmacyPHY36626CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11993007OTHERPK
2PHA3662460MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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