Provider Demographics
NPI:1558642082
Name:KELLY, MARY FRANCES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES
Last Name:KELLY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 VERNIER RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1046
Mailing Address - Country:US
Mailing Address - Phone:313-308-1006
Mailing Address - Fax:313-308-1006
Practice Address - Street 1:18000 VERNIER RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1046
Practice Address - Country:US
Practice Address - Phone:313-308-1006
Practice Address - Fax:313-308-1006
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist