Healthcare Provider Details

I. General information

NPI: 1356987515
Provider Name (Legal Business Name): CARLA SOULE-PEARSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLA SOULE PHARMD

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16705 FORT ST
SOUTHGATE MI
48195-1442
US

IV. Provider business mailing address

45540 MICHIGAN AVE
CANTON MI
48188-2472
US

V. Phone/Fax

Practice location:
  • Phone: 734-286-9220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302041454
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: