Healthcare Provider Details

I. General information

NPI: 1063320703
Provider Name (Legal Business Name): FIRST CHOICE PHARMACY OF JORDAN MN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CREEK LN S
JORDAN MN
55352-1214
US

IV. Provider business mailing address

255 CREEK LN S
JORDAN MN
55352-1214
US

V. Phone/Fax

Practice location:
  • Phone: 952-492-3334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW ROBERT KELLY
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 507-227-9678