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General NPI Number Information
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NPI Number | 1447683065
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Entity Type | Individual
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Provider Name | MATTHEW DOUGLAS DENNIS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 1730 HIGHWAY 192 W
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City | LONDON
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State | KY
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Zip | 40741-1675
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Country | US
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Telephone | 606-878-1568
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Fax |
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Provider Business Mailing Address
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Address Line | 101 VILLAS CT APT 5
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City | LONDON
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State | KY
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Zip | 40741-5002
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Country | US
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Telephone | 859-588-9765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 016523
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License Number State | KY
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