Active NPI
Kristine Marie Kelly, RPH
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Westland, MI
National Provider Identifier
1679105670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 5302029420
- Practice address
- 1750 S Wayne Rd
Westland, MI 48186-5430 - Phone
- (734) 721-3444
- Fax
- (734) 728-4197
- NPI assigned
- Feb 7, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 5302029420 | MI | Primary |
Addresses
Primary practice location
1750 S Wayne Rd
Westland, MI 48186-5430
Mailing address
1750 S Wayne Rd
Westland, MI 48186-5430
Phone (734) 721-3444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302029420 | MI | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodward Detroit CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581033600000",
"number": "1679105670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 S WAYNE RD",
"city": "WESTLAND",
"state": "MI",
"postal_code": "481865430",
"telephone_number": "734-721-3444",
"fax_number": "734-728-4197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 S WAYNE RD",
"city": "WESTLAND",
"state": "MI",
"postal_code": "481865430",
"telephone_number": "734-721-3444",
"fax_number": "734-728-4197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "KRISTINE",
"middle_name": "MARIE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-07",
"last_updated": "2020-02-07",
"certification_date": "2020-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MI",
"license": "5302029420",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.