Healthcare Provider Details

I. General information

NPI: 1457288268
Provider Name (Legal Business Name): DOUGLAS JULIAN ACKLEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 BAFFERT CT
UNION KY
41091-2008
US

IV. Provider business mailing address

805 BAFFERT CT
UNION KY
41091-2008
US

V. Phone/Fax

Practice location:
  • Phone: 937-239-5735
  • Fax:
Mailing address:
  • Phone: 937-239-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number011357
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: