MEDICARE: JOLLEY'S CORNER VARIETY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	57508311717	UT

General Provider Information

NPI Number	:	1588724397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOLLEY'S CORNER VARIETY, INC.

Provider Business Mailing Address
First Line	:	1676 E 1300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1704
Country	:	US
Telephone Number	:	801-582-1999
Fax Number	:	801-582-1270

Provider Business Practice Location Address
First Line	:	1676 E 1300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1704
Country	:	US
Telephone Number	:	801-582-1999
Fax Number	:	801-582-1270

Authorized Official
Title or Position	:	PRESIDENT
Name	:	M BRYCE JOLLEY
Credential	:
Telephone Number	:	801-582-1999

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	03/03/2015

Similar Medicare Providers

1528533429 — TREVOR JOLLEY
Practice Location Address:

1676 E 1300 S
SALT LAKE CITY, UT
84105-1704

Practice Phone: 801-582-1999
Practice Fax:

1114592722 — JOLLEY'S CORNER BUSINESSES LLC
Practice Location Address:

1676 E 1300 S
SALT LAKE CITY, UT
84105-1704

Practice Phone: 801-657-2286
Practice Fax:

1639803406 — MATTHEW BRYCE JOLLEY PHARMD
Practice Location Address:

1676 E 1300 S
SALT LAKE CITY, UT
84105-1704

Practice Phone: 801-582-1999
Practice Fax: 801-582-1270

1033465950 — SHANE BULLOCK
Practice Location Address:

5456 ARCHES DR
SALT LAKE CITY, UT
84129-1704

Practice Phone: 801-815-2833
Practice Fax:

1003327404 — ERIKA WINEGAR PHARMD
Practice Location Address:

1676 E 1300 S
SLC, UT
84105-1704

Practice Phone: 801-582-1999
Practice Fax: 801-582-1270

1750331716 — CHIROPRACTIC CENTER FOR PAIN AND REHABILITATION, LLC
Practice Location Address:

418 E COLLEGE ST
LAKE CHARLES, LA
70605-1704

Practice Phone: 337-562-0817
Practice Fax: 337-479-2391

Directions to “JOLLEY'S CORNER VARIETY, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.