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Organization
JOLLEY COMP AND SPECIALTY PHAM
Active
Organization
JOLLEY COMP AND SPECIALTY PHAM
Active
Other names
Jolley's Corner Pharmacy #3, Jolley's Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEAN JOLLEY RPH (OWNER/PHARMASIST)
(801) 484-4393
Entity
Organization
Contact information
Practice address
1702 S 1100 E, SALT LAKE CITY, UT 84105-3424
(801) 484-4393
(801) 484-8677
Mailing address
1702 S 1100 E, SALT LAKE CITY, UT 84105-3424
(801) 484-4393
(801) 484-8677
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
3318751703
UT
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2107670
PK
—
01
—
331875-1703
UTAH PHARMACY LICENSE #
UT
01
—
4602771
NCPDP
—
Enumeration date
11/17/2006
Last updated
09/29/2021
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