23D2275442 CLIA NUMBER - BROAD STREET PHARMACY

Laboratory Demographics

  • CLIA Code: 23D2275442
  • Facility Name: BROAD STREET PHARMACY
  • Facility Address: 1115 W BROAD STREET
    CHESANING, MI
    ZIP 48616
  • Facility Phone: 989 845-9355
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAMARA E. MASON
  • NPI Number: 1952864951
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2275442
LAB Type Pharmacy
Facility Name BROAD STREET PHARMACY
Street 1115 W BROAD STREET
City CHESANING
State MI
ZIP 48616
Phone 989 845-9355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2025
Certificate Expiration Date 1/22/2027
Facility Type Pharmacy
Lab Director TAMARA E. MASON

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