# JOLLEY COMP AND SPECIALTY PHAM

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Jolley's Corner Pharmacy \#3, Jolley's Compounding Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659445187
- **Authorized official:** MR. DEAN JOLLEY RPH (OWNER/PHARMASIST)
- **Authorized official phone:** (801) 484-4393

## Contact information

- **Practice address:** 1702 S 1100 E, SALT LAKE CITY, UT 84105-3424
- **Practice address phone:** (801) 484-4393
- **Practice address fax:** (801) 484-8677
- **Mailing address:** 1702 S 1100 E, SALT LAKE CITY, UT 84105-3424
- **Mailing address phone:** (801) 484-4393
- **Mailing address fax:** (801) 484-8677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 3318751703 | UT | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 09/29/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2107670 | PK | — |
| 01 | — | 331875-1703 | UTAH PHARMACY LICENSE \# | UT |
| 01 | — | 4602771 | NCPDP | — |