PENINSULA PHARMACIES INC LONG BEACH PHARMACY ANNEX (NPI# 1063048197) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063048197 |
| Entity Type | Organization |
| Organization Name | PENINSULA PHARMACIES INC LONG BEACH PHARMACY ANNEX |
| Practice Address |
110 Oregon Ave S Long Beach WA 98631 |
| Mailing Address |
Po Box B Ilwaco WA 98624-0167 |
| Practice Telephone | 3606421250 |
| Practice Fax Number | 8883082878 |
| Mailing Telephone | 3606421250 |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2020-03-20 |
| Authorized Official Name | JEFFREY SHANE HARRELL (PRESIDENT) |
| Authorized Official Telephone | 3602445984 |
| Authorized Official Credential | PHARM D |
| Is Organization Subpart | Y |
| Parent Organization Name | PENINSULA PHARMACIES INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Peninsula Compounding | Doing Business As Name - Organization |
| Street Address |
110 OREGON AVE S |
| City | LONG BEACH |
| State | WA |
| Zip Code | 98631 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033755244 | Willapa Behavioral Health | Peer Specialist | 2204 Pacific Ave. N., Long Beach, WA 98631 | 2019-11-22 |
| 1427576362 | Susan Amy Goldsmith | Social Worker | 607 Ocean Beach Blvd. N., Long Beach, WA 98631 | 2017-08-30 |
| 1558724302 | Jesse Wityczak | Pharmacist | 101 Bolstad Ave E, Long Beach, WA 98631 | 2016-03-30 |
| 1659618007 | Teresa Mary Fleck | Speech-Language Pathologist | 400 S Washington, Long Beach, WA 98631 | 2013-01-04 |
| 1639400385 | Wendy Liu | Counselor | 2204 Pacififc Avenue N, Long Beach, WA 98631 | 2010-01-20 |
| 1093046088 | Diane L Adams | Counselor | 2204 Pacific Avenue N, Long Beach, WA 98631 | 2010-01-15 |
| 1538498076 | Steven R Fox | Counselor | 22004 Pacific Way N, Long Beach, WA 98631 | 2009-12-11 |
| 1295907137 | Brandon L Adams Md Ps | General Practice | 105 6th St, Long Beach, WA 98631 | 2008-04-01 |
| 1710188263 | Willapa Counseling Center | Clinic/Center | 1107 Pacific Avenue North, Long Beach, WA 98631 | 2007-05-31 |
| 1720204779 | Darren L Thorsen, Od | Optometrist | 1703 South Pacific Ave, Long Beach, WA 98631 | 2007-04-18 |
| Find all providers in zip 98631 | ||||
| Taxonomy Code | 3336C0004X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Compounding Pharmacy |
| A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner’s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. |
| Notes: Sources: NABP Model Practice Act, Appendix C - Good Compounding Practice, USP <795> and <797>, and Pharmacy Compounding Accreditation Board [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184055584 | Fusion Quest Inc | Pharmacy | 2690 Pacific Ave, Unit 100, Long Beach, CA 90806-2657 | 2013-12-10 |
| 1902106453 | Chem Rx Pharmacy Services, LLC | Pharmacy | 790 Park Pl, Long Beach, NY 11561-2111 | 2010-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417581943 | Jike LLC | Pharmacy | 8614 E Mill Plain Blvd Ste 110, Vancouver, WA 98664-2058 | 2020-02-24 |
| 1518444025 | Columbia Pharmacy | Pharmacy | 2700 Ne Andresen Rd Ste E3, Vancouver, WA 98661 | 2018-07-26 |
| 1730500067 | Kelley-ross and Assoc, Inc. | Pharmacy | 805 Madison St # 702, Seattle, WA 98104-1172 | 2014-01-06 |
| 1962779348 | Poulsbo Compounding Pharmacy LLC | Pharmacy | 325 Ne Hostmark Street, Poulsbo, WA 98370 | 2011-11-29 |
| 1114237633 | Poulsbo Compounding Pharmacy LLC | Pharmacy | 325 Ne Hostmark St, Poulsbo, WA 98370-6668 | 2010-10-18 |
| 1750601472 | Sound Apothecaries | Pharmacy | 1851 State Ave Ne Ste 105, Olympia, WA 98506-4601 | 2010-06-03 |
| 1699094417 | Darvic Assoc. Inc. | Pharmacy | 1907 Harrison Ave Nw, Olympia, WA 98502-5118 | 2010-05-18 |
| 1093961146 | Mipa Corp | Pharmacy | 4629 168th St Sw Ste A, Lynnwood, WA 98037-8640 | 2008-08-08 |
| 1578760260 | Pharmaca Integrative Pharmacy, Inc. | Pharmacy | 1815 N. 45th Street, Suite 110, Seattle, WA 98103 | 2007-06-27 |
| 1528199619 | Don's Pharmacy Inc. | Pharmacy | 1151 Water St, Port Townsend, WA 98368-6707 | 2007-03-08 |
| Find all providers with the same taxonomy | ||||
| City | LONG BEACH |
| Zip Code | 98631 |
Please comment or provide details below to improve the information on PENINSULA PHARMACIES INC LONG BEACH PHARMACY ANNEX.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.