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General NPI Number Information
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NPI Number | 1235388430
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Entity Type | Organization
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Legal Business Name | JOLLYS PHARMACY INC
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 09/13/2017
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Provider Practice Location Address
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Address Line | 1412 SW 43RD ST SUITE 120
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City | RENTON
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State | WA
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Zip | 98057-4803
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Country | US
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Telephone | 425-251-6335
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Fax | 425-251-6337
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Provider Business Mailing Address
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Address Line | 1412 SW 43RD ST STE 120
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City | RENTON
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State | WA
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Zip | 98057-4803
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Country | US
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Telephone | 425-251-6335
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Fax | 425-251-6337
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Authorized Official
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Title or Position | OWNER
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Name | ANDERSON S. JOLLY
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Credential | BS C PHARM
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Telephone | 425-251-6335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHAR.CF.60065440
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License Number State | WA
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