Individual
SHANE PATRICK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
839 FARMINGTON AVE, BRISTOL, CT 06010-3922
(860) 582-8167
Mailing address
839 FARMINGTON AVE, BRISTOL, CT 06010-3922
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PCT.0013529
CT
Other
Enumeration date
04/29/2016
Last updated
04/29/2016
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