Healthcare Provider Details

I. General information

NPI: 1447683065
Provider Name (Legal Business Name): MATTHEW DOUGLAS DENNIS CLINICAL PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 US HIGHWAY 127 S
FRANKFORT KY
40601-4411
US

IV. Provider business mailing address

1309 US HIGHWAY 127 S
FRANKFORT KY
40601-4358
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-1568
  • Fax:
Mailing address:
  • Phone: 502-875-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number016523
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: