Provider Demographics
NPI:1073923892
Name:NIELSEN, KELLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10682 W HILLIS RD
Mailing Address - Street 2:
Mailing Address - City:TRUFANT
Mailing Address - State:MI
Mailing Address - Zip Code:49347-9724
Mailing Address - Country:US
Mailing Address - Phone:989-621-6970
Mailing Address - Fax:
Practice Address - Street 1:1015 E PICKARD ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1062
Practice Address - Country:US
Practice Address - Phone:989-775-2133
Practice Address - Fax:989-775-2165
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist