1. Home
  2. Directory
  3. Michigan
  4. Marquette
  5. Pharmacy
  6. NPI Profile

PENINSULA PHARMACY
NPI 1003807413
Pharmacy - Community/Retail Pharmacy in Marquette, MI

Active since November 03, 2005CLIA 23D2206077 · Waiver
1414 W FAIR AVE, SUITE 133, MARQUETTE, MI 49855(906) 225-3902(906) 226-2661 Get Directions Write a Review

NPPES record last updated: December 18, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 18, 2024, Nov 16, 2022, Sep 7, 2021 (3 updates tracked since 2021).

About Peninsula Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENINSULA PHARMACY (NPI 1003807413) is a healthcare organization registered as a community/retail pharmacy in Marquette, Michigan and active in the NPI registry since November 2005. The organization holds a CLIA Waiver certificate valid through December 16, 2026 and lists Praveen Challa, President, as its authorized official.

NPPES Registry Identity

NPI1003807413
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NamePENINSULA PHARMACY INC
Location Address1414 W FAIR AVE, SUITE 133Marquette, MI 49855-2675
Mailing Address1414 W Fair Ave, Suite 133Marquette, MI 49855-2675 · (906) 225-3902 · Fax (906) 226-2661
Phone(906) 225-3902
Fax(906) 226-2661
Organization SubpartNo
Authorized OfficialPraveen ChallaPresident · (906) 225-3902
Enumeration DateNovember 3, 2005
Last NPPES UpdateDecember 18, 20243 updates tracked since enumeration
NPPES CertifiedDecember 18, 2024
✔ NPI 1003807413 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in MI · 5301010345
Definition
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.
Also ListedPharmacistTaxonomy 183500000X · License 5301010345 (MI)
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X · License 1199700001 (MI)
Also ListedDurable Medical Equipment & Medical Supplies · Parenteral & Enteral NutritionTaxonomy 332BP3500X · License 1003807413 (MI)
Also ListedPharmacy · Home Infusion Therapy PharmacyTaxonomy 3336H0001X · License 5301010345 (MI)
1414 W FAIR AVE, Marquette, MI 49855
Open in Google Maps ↗

Other Names 1

Doing Business AsPeninsula Pharmacy

Other Identifiers 3

Medicaid3409001MI
Other1003807413MI · Bcbs - Michigan
Other2357362MI · Ncpdp

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D2206077

Peninsula Pharmacy · Marquette, MI
Active · expires Dec 16, 2026
CLIA Number23D2206077
Laboratory TypePharmacy
Certificate Effective DateDecember 17, 2024
Certificate Expiration DateDecember 16, 2026
Laboratory DirectorTyler J. Jenema
Laboratory Phone(906) 225-3902
Laboratory LocationPeninsula Pharmacy1414 W Fair Avenue Suite 133, Marquette, MI 49855
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
39 services39 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
31 services31 patients

Medical Equipment Supplier Medicare DMEPOS 23

Medicare supplier enrollment and the product categories Peninsula Pharmacy carries, from the Medicare DMEPOS supplier directory.

Peninsula Pharmacy

DMEPOS supplier · Marquette, MIOperated by Peninsula Pharmacy Inc
⋮

Does not accept Medicare assignment

Peninsula Pharmacy has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20623283
Medicare Participant SinceJanuary 1, 2001
Supplier Location1414 W Fair Ave Ste 133Marquette, MI 49855
Phone(906) 225-3902
Supplier Specialties
Certified Other Pharmacy

Medicare Product Categories

Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Commodes, Urinals, Bedpans
Raised toilets, Drop-arm commodes, Folding commodes, Plastic urinals, Plastic bedpans, Disposable urinals
Blood Glucose Monitors/Supplies (Non-Mail Order)
Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. KIRK W MATTHEWS LMSW
Social Worker (Clinical)
1414 W FAIR AVE
MARQUETTE, MI 49855
Marquette County (906) 774-3300
MR. STEVEN M GUALDONI PAC
Physician Assistant
1414 W FAIR AVE, STE 332
MARQUETTE, MI 49855
Marquette County (906) 225-3922
BOBBY Z JOSEPH M.D.
Allergy & Immunology
1414 W FAIR AVE, SUITE 216
MARQUETTE, MI 49855
Marquette County (906) 225-4725
NATHAN SAMUEL TAYLOR MD
Plastic Surgery (Surgery of the Hand)
1414 W FAIR AVE, SUITE 190
MARQUETTE, MI 49855
Marquette County (906) 225-1321
DR. PUSHPAMAL NAYANANGA SAMARARATNE MD
Student in an Organized Health Care Education/Training Program
1414 W FAIR AVE, SUITE 24
MARQUETTE, MI 49855
Marquette County (906) 225-3864
RODNEY RIESLAND NP
Nurse Practitioner (Primary Care)
1414 W FAIR AVE, STE 344
MARQUETTE, MI 49855
Marquette County (906) 225-3910
MANSOUR MIKY M.D.
Physical Medicine & Rehabilitation
1414 W FAIR AVE, SUITE 204
MARQUETTE, MI 49855
Marquette County (906) 225-7740
ERIC L HOOPER O.D.
Optometrist
1414 W FAIR AVE, SUITE 347
MARQUETTE, MI 49855
Marquette County (906) 225-4512

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Peninsula Pharmacy Inc's NPI number?

The NPI number for Peninsula Pharmacy Inc is 1003807413. It was assigned to this organization in the NPPES registry on November 3, 2005. The provider is doing business as Peninsula Pharmacy.

Where is Peninsula Pharmacy Inc located?

Peninsula Pharmacy Inc is located at 1414 W Fair Ave Suite 133, Marquette, MI 49855. The listed phone number is (906) 225-3902.

What is Peninsula Pharmacy Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Peninsula Pharmacy Inc accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Peninsula Pharmacy does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Peninsula Pharmacy Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D2206077) is associated with this NPI, valid through December 16, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Peninsula Pharmacy Inc accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 50 other insurers list Peninsula Pharmacy Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Peninsula Pharmacy Inc was last updated on December 18, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.