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NPI Code Detail

MEDICARE: PENINSULA COMMUNITY HEALTH SERVICES

MEDICARE: PENINSULA COMMUNITY HEALTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPHARCF00058729WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12108674OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588675623
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENINSULA COMMUNITY HEALTH SERVICES
Provider Business Mailing Address
First Line : PO BOX 960
Second Line :
City : BREMERTON
State : WA
Zip : 98337-0212
Country : US
Telephone Number : 360-478-2366
Fax Number : 360-373-2096
Provider Business Practice Location Address
First Line : 320 S KITSAP BLVD
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-3778
Country : US
Telephone Number : 360-874-5583
Fax Number : 360-895-5654
Authorized Official
Title or Position : CEO
Name : JENNIFER KREIDLER-MOSS
Credential : PHARMD
Telephone Number : 360-478-2833
Provider Enumeration Date : 08/11/2006
Last Update Date : 09/16/2016

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Directions to “PENINSULA COMMUNITY HEALTH SERVICES ” Practice Location

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