Healthcare Provider Details

I. General information

NPI: 1659469146
Provider Name (Legal Business Name): CAROLE L. DELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST
YALE MI
48097-3317
US

IV. Provider business mailing address

3090 KENDA CT
CLYDE MI
48049-4311
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-4244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302023418
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: