Healthcare Provider Details

I. General information

NPI: 1770493066
Provider Name (Legal Business Name): HANNAH SHELTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 S TELEGRAPH RD
BLOOMFIELD TOWNSHIP MI
48302-0254
US

IV. Provider business mailing address

2998 FRUITPORT RD
FRUITPORT MI
49415-9634
US

V. Phone/Fax

Practice location:
  • Phone: 248-836-1603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302419231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: