23D2206077 CLIA NUMBER - PENINSULA PHARMACY

Laboratory Demographics

  • CLIA Code: 23D2206077
  • Facility Name: PENINSULA PHARMACY
  • Facility Address: 1414 W FAIR AVENUE SUITE 133
    MARQUETTE, MI
    ZIP 49855
  • Facility Phone: 906 225-3902
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYLER J. JENEMA
  • NPI Number: 1366943995
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2206077
LAB Type Pharmacy
Facility Name PENINSULA PHARMACY
Street 1414 W FAIR AVENUE SUITE 133
City MARQUETTE
State MI
ZIP 49855
Phone 906 225-3902
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Pharmacy
Lab Director TYLER J. JENEMA

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This page was last updated on: 9/29/2025