# KELLEY PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Custom Prescription Shoppe
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366578114
- **Authorized official:** MR. SCOTT WILLIAM BROWN III R.PH. (OWNER PHARMACIST)
- **Authorized official phone:** (802) 864-0812

## Contact information

- **Practice address:** 42 TIMBER LN, SOUTH BURLINGTON, VT 05403-7204
- **Practice address phone:** (802) 864-0812
- **Mailing address:** 42 TIMBER LN, SOUTH BURLINGTON, VT 05403-7204
- **Mailing address phone:** (802) 864-0812

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 038-0002622 | VT | Yes |

## Other

- **Enumeration date:** 02/26/2007
- **Last updated:** 08/22/2020