Provider Demographics
NPI:1760579569
Name:KELLY, SHEILAH CARTER (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:SHEILAH
Middle Name:CARTER
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 NORTH OXFORD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1852
Mailing Address - Country:US
Mailing Address - Phone:313-881-8947
Mailing Address - Fax:
Practice Address - Street 1:22151 MOROSS RD
Practice Address - Street 2:SUITE G-25
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-1852
Practice Address - Country:US
Practice Address - Phone:313-343-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020232161835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy