MEDICARE: TREVOR JOLLEY

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	5029548-1701	UT

General Provider Information

NPI Number	:	1528533429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR JOLLEY

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	:

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

Provider Enumeration Date	:	10/06/2018
Last Update Date	:	10/06/2018

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Directions to “ TREVOR JOLLEY ” Practice Location

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