Healthcare Provider Details

I. General information

NPI: 1710095831
Provider Name (Legal Business Name): KELBEL PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MAIN ST
HARBOR SPRINGS MI
49740-1511
US

IV. Provider business mailing address

205 E MAIN ST
HARBOR SPRINGS MI
49740-1511
US

V. Phone/Fax

Practice location:
  • Phone: 231-526-5971
  • Fax: 231-526-0376
Mailing address:
  • Phone: 231-526-5971
  • Fax: 231-526-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number6380
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301006380
License Number StateMI

VIII. Authorized Official

Name: MS. LEANNE KELBEL
Title or Position: OWNER/MANAGER
Credential:
Phone: 231-526-5971