Jolley Comp and Specialty Pham

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

3318751703 Issued in UT

Legal business name

JOLLEY COMP AND SPECIALTY PHAM

Practice address

1702 S 1100 E
Salt Lake City, UT 84105-3424

Phone

(801) 484-4393

Fax

(801) 484-8677

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Dean Jolley, RPH

Title

Owner/Pharmasist

Phone

(801) 484-4393

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 2

• Jolley's Compounding Pharmacy Doing business as
• Jolley's Corner Pharmacy #3 Former legal business name

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 5

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

• Benjamin Dean Jolley, PHARMD

  • Ambulatory Care Pharmacist
  • Salt Lake City, UT
  • NPI 1831703198
  NPD
• Leo Dean Jolley, RPH

  • Ambulatory Care Pharmacist
  • Salt Lake City, UT
  • NPI 1073247268
  NPD
• Connie Sunju Hansen, PHARMD

  • Pharmacist
  • Salt Lake City, UT
  • NPI 1972256436
  NPD (past)
• Akram Refaat, RPH

  • Pharmacist
  • Salt Lake City, UT
  • NPI 1962019703
  NPD (past)
• Spencer Lloyd Simister, PHARMD

  • Pharmacist
  • Salt Lake City, UT
  • NPI 1710630140
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1659445187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 S 1100 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841053424",
            "telephone_number": "801-484-4393",
            "fax_number": "801-484-8677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 S 1100 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841053424",
            "telephone_number": "801-484-4393",
            "fax_number": "801-484-8677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOLLEY COMP AND SPECIALTY PHAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "JOLLEY",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "OWNER/PHARMASIST",
        "authorized_official_telephone_number": "801-484-4393",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "3318751703",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2107670",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH PHARMACY LICENSE #",
            "identifier": "331875-1703",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4602771",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jolley's Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jolley's Corner Pharmacy #3",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Stephanie Rose Johnston
• Robert Derrel Johnstun
• David Gordon Joiner, PT, DPT, OCS
• Tara Joiner, MPT
• Anncheri Joklik, BS, RN
• Ariel Jolley
• Benjamin Dean Jolley, PHARMD
• Chad Jolley, PHARM D
• Elisabeth K. Jolley, MSW, LCSW
• Hailie Sandra Jolley

• Community/Retail Pharmacy in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Community/Retail Pharmacy in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.