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General NPI Number Information
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NPI Number | 1063320703
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Entity Type | Organization
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Legal Business Name | FIRST CHOICE PHARMACY OF JORDAN MN, PLLC
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 255 CREEK LN S
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City | JORDAN
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State | MN
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Zip | 55352-1214
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Country | US
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Telephone | 952-492-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 255 CREEK LN S
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City | JORDAN
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State | MN
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Zip | 55352-1214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MATTHEW ROBERT KELLY
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Credential | PHARMD
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Telephone | 507-227-9678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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