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General NPI Number Information
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NPI Number | 1558359877
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Entity Type | Organization
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Legal Business Name | PENINSULA PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 11833 CANON BLVD STE 114
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2589
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Country | US
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Telephone | 757-594-3944
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Fax | 757-594-3950
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Provider Business Mailing Address
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Address Line | 608 DENBIGH BLVD STE 800
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-4410
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Country | US
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Telephone | 757-875-7545
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Fax | 757-875-7553
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MIKE BOGGS
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Credential |
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Telephone | 757-594-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 0201003424
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License Number State | VA
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