Provider Demographics
NPI:1245573286
Name:FIRST CHOICE PHARMACY OF JORDAN PC
Entity Type:Organization
Organization Name:FIRST CHOICE PHARMACY OF JORDAN PC
Other - Org Name:FIRST CHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:REINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-492-3334
Mailing Address - Street 1:255 CREEK LN S
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-1214
Mailing Address - Country:US
Mailing Address - Phone:952-492-3334
Mailing Address - Fax:952-492-3344
Practice Address - Street 1:255 CREEK LN S
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-1214
Practice Address - Country:US
Practice Address - Phone:952-492-3334
Practice Address - Fax:952-492-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MN2645133336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1245573286Medicaid
2147477OtherPK