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NPI Code Detail

MEDICARE: DR. KELLY NIELSEN PHARMD

MEDICARE: DR. KELLY NIELSEN PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302037269MI

General Provider Information

NPI Number : 1073923892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY NIELSEN PHARMD
Provider Business Mailing Address
First Line : 10682 W HILLIS RD
Second Line :
City : TRUFANT
State : MI
Zip : 49347-9724
Country : US
Telephone Number : 989-621-6970
Fax Number :
Provider Business Practice Location Address
First Line : 1015 E PICKARD ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-1062
Country : US
Telephone Number : 989-775-2133
Fax Number : 989-775-2165
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2014
Last Update Date : 05/01/2014

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