Provider Demographics
NPI:1770866683
Name:DAUGHERTY, DENNIS LEE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEE
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 DIXIE HWY
Mailing Address - Street 2:WALGREENS #09524
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-3949
Mailing Address - Country:US
Mailing Address - Phone:502-933-4001
Mailing Address - Fax:
Practice Address - Street 1:10201 DIXIE HWY
Practice Address - Street 2:WALGREENS #09524
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3949
Practice Address - Country:US
Practice Address - Phone:502-933-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist