Individual
MATTHEW KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3225 10TH ST E, GLENCOE, MN 55336-3369
(320) 864-5026
Mailing address
3225 10TH ST E, GLENCOE, MN 55336-3369
(320) 864-5026
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
120522
MN
Other
Enumeration date
03/31/2014
Last updated
03/31/2014
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