Provider Demographics
NPI:1114592722
Name:JOLLEY'S CORNER BUSINESSES LLC
Entity Type:Organization
Organization Name:JOLLEY'S CORNER BUSINESSES LLC
Other - Org Name:JOLLEYS CORNER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-582-1600
Mailing Address - Street 1:1676 E 1300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1704
Mailing Address - Country:US
Mailing Address - Phone:801-582-1600
Mailing Address - Fax:
Practice Address - Street 1:1676 E 1300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-1704
Practice Address - Country:US
Practice Address - Phone:801-657-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy