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NPI Code Detail

MEDICARE: SANDRA JOLY

MEDICARE: SANDRA JOLY
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
1183500000XPharmacistS009008AZ

General Provider Information

NPI Number : 1811444185
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANDRA JOLY
Provider Business Mailing Address
First Line : 4514 E WELDON AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-6039
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4514 E WELDON AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-6039
Country : US
Telephone Number : 602-421-0098
Fax Number :
Authorized Official
Title or Position : PHARMACIST
Name : SANDRA JOLY
Credential :
Telephone Number : 602-421-0098
Provider Enumeration Date : 09/04/2016
Last Update Date : 09/04/2016

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