Provider Demographics
NPI:1831703198
Name:JOLLEY, BENJAMIN DEAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DEAN
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 1:1702 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3424
Mailing Address - Country:US
Mailing Address - Phone:801-484-4393
Mailing Address - Fax:801-484-8677
Practice Address - Street 1:1702 S 1100 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3424
Practice Address - Country:US
Practice Address - Phone:801-484-4393
Practice Address - Fax:801-484-8677
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7050817-17011835P2201X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7050817-1701OtherSTATE PHARMACIST LICENSE