Provider Demographics
NPI:1437763455
Name:MEKEEL, DALIA J (PHARMD)
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:J
Last Name:MEKEEL
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 1:33735 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6343
Mailing Address - Country:US
Mailing Address - Phone:248-729-1474
Mailing Address - Fax:
Practice Address - Street 1:33 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1701
Practice Address - Country:US
Practice Address - Phone:248-546-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1731394OtherDO NOT HAVE ONE
MI1731394Medicaid