Provider Demographics
NPI:1922006543
Name:SAMUELS, KIELA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIELA
Middle Name:M
Last Name:SAMUELS
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 1:1549 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-4147
Mailing Address - Country:US
Mailing Address - Phone:734-547-9100
Mailing Address - Fax:734-547-9144
Practice Address - Street 1:24 FRANK LLOYD WRIGHT DR.
Practice Address - Street 2:H-2100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-0442
Practice Address - Country:US
Practice Address - Phone:734-547-9100
Practice Address - Fax:734-547-9144
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist