Healthcare Provider Details

I. General information

NPI: 1376142331
Provider Name (Legal Business Name): JOHN JOLLY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 W LOCUST ST
WILMINGTON OH
45177-2180
US

IV. Provider business mailing address

8859 W BERRYSVILLE RD
HILLSBORO OH
45133-8666
US

V. Phone/Fax

Practice location:
  • Phone: 937-382-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03331321
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: