Healthcare Provider Details

I. General information

NPI: 1922928563
Provider Name (Legal Business Name): KELLY COPELAND PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N GLENGARRY RD
BLOOMFIELD HILLS MI
48301-2715
US

IV. Provider business mailing address

375 N GLENGARRY RD
BLOOMFIELD HILLS MI
48301-2715
US

V. Phone/Fax

Practice location:
  • Phone: 248-506-7227
  • Fax:
Mailing address:
  • Phone: 248-506-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14606
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: