Provider Demographics
NPI:1639803406
Name:JOLLEY, MATTHEW BRYCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRYCE
Last Name:JOLLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:801-582-1999
Mailing Address - Fax:801-582-1270
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:801-582-1999
Practice Address - Fax:801-582-1270
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12322305-17033336C0004X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No3336C0004XSuppliersPharmacyCompounding Pharmacy