Healthcare Provider Details

I. General information

NPI: 1760579569
Provider Name (Legal Business Name): SHEILAH CARTER KELLY PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS RD SUITE G-25
DETROIT MI
48236-1852
US

IV. Provider business mailing address

970 NORTH OXFORD
GROSSE POINTE WOODS MI
48236-1852
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-3776
  • Fax:
Mailing address:
  • Phone: 313-881-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302023216
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: