MEDICARE: PROF. BARBARA LEE JOLLY RPH, MPA

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	183500000X	Pharmacist	010129	KY

General Provider Information

NPI Number	:	1417262098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. BARBARA LEE JOLLY RPH, MPA

Provider Business Mailing Address
First Line	:	2100 GARDINER LN
Second Line	:	SULLIVAN UNIVERSITY COLLEGE OF PHARMACY
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2962
Country	:	US
Telephone Number	:	502-413-8956
Fax Number	:	502-515-4669

Provider Business Practice Location Address
First Line	:	2100 GARDINER LN
Second Line	:	SULLIVAN UNIVERSITY COLLEGE OF PHARMACY
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2962
Country	:	US
Telephone Number	:	502-413-8956
Fax Number	:	502-515-4669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2010
Last Update Date	:	01/11/2026

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