Organization Active NPI

Jollys Pharmacy Inc

  • Long Term Care Pharmacy
  • Renton, WA
National Provider Identifier
1235388430
Registry record updated Sep 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHAR.CF.60065440 Issued in WA
Legal business name
JOLLYS PHARMACY INC
Doing business as
Ready Meds Pharmacy
Practice address
1412 SW 43Rd St
Suite 120
Renton, WA 98057-4803
Phone
(425) 251-6335
Fax
(425) 251-6337
NPI assigned
Sep 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anderson S. Jolly, BS C PHARMNPI 1245353234
Title
Owner
Phone
(425) 251-6335

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X PHAR.CF.60065440 WA Primary

Addresses

Primary practice location

1412 SW 43Rd St
Suite 120
Renton, WA 98057-4803

Mailing address

1412 SW 43Rd St Ste 120
Renton, WA 98057-4803
Phone (425) 251-6335

Other identifiers 1

IdentifierTypeStateIssuer
2007021MedicaidWA

Other names 1

  • Ready Meds Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120103000687 WA DME Supplier - Pharmacy 4981870581 Practice locations: Renton, WA
O20120716000602 WA Part B Supplier - Mass Immunization (Roster Biller Only) 4981870581 Practice locations: Renton, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Jollys Pharmacy1412 SW 43Rd St, Renton, WA 98057-4803(425) 251-6335 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order) Accepts assignmentParticipating since Apr 25, 2012

National Provider Directory

National Provider Directory

Locations

1412 SW 43rd St
#120B
Renton, WA 98057
Phone (425) 251-6335

1412 SW 43rd St
Ste 120B
Renton, WA 98057

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505260800000",
    "number": "1235388430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 SW 43RD ST STE 120",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574803",
            "telephone_number": "425-251-6335",
            "fax_number": "425-251-6337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 SW 43RD ST",
            "address_2": "SUITE 120",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574803",
            "telephone_number": "425-251-6335",
            "fax_number": "425-251-6337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOLLYS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2017-09-13",
        "status": "A",
        "authorized_official_last_name": "JOLLY",
        "authorized_official_first_name": "ANDERSON",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-251-6335",
        "authorized_official_credential": "BS C PHARM"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.60065440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2007021",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ready Meds Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.