Healthcare Provider Details

I. General information

NPI: 1003462508
Provider Name (Legal Business Name): SHELBY ELEANOR KELSH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE STE 2100
GRAND RAPIDS MI
49503-2526
US

IV. Provider business mailing address

7875 ALPINE AVE
SPARTA MI
49345-9385
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302043723
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: