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General NPI Number Information
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NPI Number | 1598559791
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Entity Type | Organization
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Legal Business Name | KELLY PHARMACY LLC
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 21321 KELLY RD STE 110
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City | EASTPOINTE
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State | MI
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Zip | 48021-3214
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Country | US
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Telephone | 586-981-0966
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Fax | 586-981-0983
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Provider Business Mailing Address
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Address Line | 21321 KELLY RD STE 110
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City | EASTPOINTE
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State | MI
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Zip | 48021-3214
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Country | US
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Telephone | 586-981-0966
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Fax | 586-981-0983
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Authorized Official
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Title or Position | OWNER
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Name | NADA DAKROUB
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Credential |
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Telephone | 313-377-6623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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