JOLLEY'S CORNER VARIETY, INC. (NPI# 1588724397) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588724397 |
| Entity Type | Organization |
| Organization Name | JOLLEY'S CORNER VARIETY, INC. |
| Other Organization Name | JOLLEYS CORNER PHARMACY |
| Practice Address |
1676 E 1300 S Salt Lake City UT 84105-1704 |
| Practice Telephone | 8015821999 |
| Practice Fax Number | 8015821270 |
| Mailing Telephone | 8015821999 |
| Mailing Fax Number | 8015821270 |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2015-03-03 |
| Authorized Official Name | M BRYCE JOLLEY (PRESIDENT) |
| Authorized Official Telephone | 8015821999 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183700000X | Pharmacy Technician | 57508311717 | UT | Pharmacy Service Providers |
| Other Name | Type Code |
|---|---|
| JOLLEYS CORNER PHARMACY | Doing Business As Name - Organization |
| Street Address |
1676 E 1300 S |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84105-1704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528533429 | Trevor Jolley | Pharmacist | 1676 E 1300 S, Salt Lake City, UT 84105-1704 | 2018-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285106237 | Laiyan H Bawadeen | Counselor | 1425 700 E Suite #102, Salt Lake City, UT 84105 | 2018-12-31 |
| 1639644255 | Claire Elizabeth Gray | Marriage & Family Therapist | 1425 700 East, Salt Lake City, UT 84105 | 2018-10-10 |
| 1083089643 | Celisa Packer | Social Worker | 2020 E Lake St, Salt Lake City, UT 84105 | 2015-12-08 |
| 1083052963 | Christina Elizabeth Burton | Nurse Practitioner | 1008 S 1100 E, Apt 6, Salt Lake City, UT 84105 | 2013-06-12 |
| 1649548355 | Leland Burt Cowan | Surgery | 1405 Princeton Ave, Salt Lake City, UT 84105 | 2011-12-08 |
| 1639460355 | Sally Cathleen Webster | Counselor | 1248 Yale Avenue, Salt Lake City, UT 84105 | 2011-04-28 |
| 1912205105 | Melissa Wilson | Case Manager/Care Coordinator | 1522 S 1100 E, Salt Lake City, UT 84105 | 2011-03-11 |
| 1013215789 | Tamara Marie Wright | Counselor | 1996 Lake St, Salt Lake City, UT 84105 | 2011-03-04 |
| 1144527243 | Crystal Nicole Garduno | Counselor | 1522 South 1100 East, Salt Lake City, UT 84105 | 2011-02-25 |
| 1508011180 | Keith Elliott | Anesthesiology | 1552 South 1000 East, Salt Lake City, UT 84105 | 2008-11-24 |
| Find all providers in zip 84105 | ||||
| Taxonomy Code | 183700000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacy Technician |
| A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |
| Notes: Source: Pharmacy Technician Certification Board, www.ptcb.org [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245796358 | Crystal Paredes | Pharmacy Technician | 1020 S Main St Ste 110, Salt Lake City, UT 84101-3176 | 2019-02-13 |
| 1982144341 | Sharlena Schacht | Pharmacy Technician | 1040 North 2200 West, Salt Lake City, UT 84116 | 2017-03-06 |
| 1265546584 | Jason Allen Dunn | Pharmacy Technician | 1260 E Vine St, Salt Lake City, UT 84121 | 2006-08-17 |
| 1700487048 | Michelle Teresa Wilcock | Pharmacy Technician | 4460 S Highland Dr Ste 210, Salt Lake City, UT 84124-3550 | 2020-11-03 |
| 1023621232 | Thomas Alan Good Lance White Bull | Pharmacy Technician | 500 Foothill Dr, Salt Lake City, UT 84148-0001 | 2020-08-26 |
| 1073125373 | Brenda Lee Waller | Pharmacy Technician | 729 N Redwood Rd, Salt Lake City, UT 84116-1909 | 2020-08-18 |
| 1134738792 | Bailee Marie Anderson | Pharmacy Technician | 4460 S Highland Dr Ste 210, Salt Lake City, UT 84124-3550 | 2020-07-29 |
| 1538788013 | Andrew Ronald Johnson | Pharmacy Technician | 500 Foothill Dr, Salt Lake City, UT 84148-0001 | 2020-04-14 |
| 1821562760 | Christopher Davis | Pharmacy Technician | 1020 S Main St, Salt Lake City, UT 84101-3176 | 2019-01-14 |
| 1730660622 | Aubrey Nielsen | Pharmacy Technician | 4460 S Highland Dr, Salt Lake City, UT 84124-3543 | 2018-08-28 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.