Active NPI
Matthew K Kelly, PHARM. D,
- Pharmacist
- Bloomington, MN
National Provider Identifier
1255618559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 119746
- Practice address
- 8421 Lyndale Ave S
Bloomington, MN 55420-4580 - Phone
- (952) 346-8625
- Fax
- (952) 948-0686
- NPI assigned
- Nov 15, 2011
- Last updated
- Nov 11, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 119746 | MN | Primary |
Addresses
Primary practice location
8421 Lyndale Ave S
Bloomington, MN 55420-4580
Mailing address
3800 Lexington Ave N
T0619
Shoreview, MN 55126-2916
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119746 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supervalu Pharmacies Inc. | Past | Accepting new patients | |
| Supervalu Pharmacies Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762819200000",
"number": "1255618559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3800 LEXINGTON AVE N",
"address_2": "T0619",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551262916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8421 LYNDALE AVE S",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554204580",
"telephone_number": "952-346-8625",
"fax_number": "952-948-0686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MATTHEW",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PHARM. D,",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-15",
"last_updated": "2025-11-11",
"certification_date": "2025-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "119746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.