MEDICARE: JOLLEY'S CORNER BUSINESSES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	183700000X	Pharmacy Technician
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1114592722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOLLEY'S CORNER BUSINESSES LLC

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	:	801-582-1600
Fax Number	:

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	:	801-657-2286
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRIS KENDRICK
Credential	:
Telephone Number	:	801-582-1600

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	06/23/2021

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Directions to “JOLLEY'S CORNER BUSINESSES LLC ” Practice Location

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