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General NPI Number Information
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NPI Number | 1194247197
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Entity Type | Individual
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Provider Name | JEREMY KELM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 21936 VASSAR AVE
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City | HAZEL PARK
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State | MI
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Zip | 48030-1828
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Country | US
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Telephone | 248-546-0494
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Fax |
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Provider Business Mailing Address
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Address Line | 910 SEWARD ST RM 306
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City | DETROIT
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State | MI
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Zip | 48202-2351
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Country | US
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Telephone | 248-762-3127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302041627
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License Number State | MI
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