Provider Demographics
NPI:1235388430
Name:JOLLYS PHARMACY INC
Entity Type:Organization
Organization Name:JOLLYS PHARMACY INC
Other - Org Name:READY MEDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDERSON
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:BS C PHARM
Authorized Official - Phone:425-251-6335
Mailing Address - Street 1:1412 SW 43RD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4803
Mailing Address - Country:US
Mailing Address - Phone:425-251-6335
Mailing Address - Fax:425-251-6337
Practice Address - Street 1:1412 SW 43RD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4803
Practice Address - Country:US
Practice Address - Phone:425-251-6335
Practice Address - Fax:425-251-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.600654403336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2007021Medicaid
WA6617820001Medicare NSC