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General NPI Number Information
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NPI Number | 1255416038
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Entity Type | Organization
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Legal Business Name | PENINSULA PHARMACIES INC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 101 1ST AVE SOUTH
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City | ILWACO
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State | WA
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Zip | 98624
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Country | US
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Telephone | 360-642-3133
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Fax | 360-642-5133
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Provider Business Mailing Address
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Address Line | PO BOX B
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City | ILWACO
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State | WA
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Zip | 98624-0167
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Country | US
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Telephone | 360-642-3133
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Fax | 360-642-5133
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. TOM SUTHERLAND
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Credential | RPH
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Telephone | 360-642-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | CF00000398
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License Number State | WA
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