Healthcare Provider Details

I. General information

NPI: 1447642053
Provider Name (Legal Business Name): MR. BRIAN RICKERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 CHESTNUT DR
WALTON KY
41094-7841
US

IV. Provider business mailing address

635 CHESTNUT DR
WALTON KY
41094-7841
US

V. Phone/Fax

Practice location:
  • Phone: 859-379-0030
  • Fax: 859-379-0031
Mailing address:
  • Phone: 859-379-0030
  • Fax: 859-379-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number011314
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: