Healthcare Provider Details

I. General information

NPI: 1821781113
Provider Name (Legal Business Name): KENNETH SCOTT WOODALL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22265 E QUEEN CREEK RD
QUEEN CREEK AZ
85142-9801
US

IV. Provider business mailing address

23056 E CAMINA BUENA VIS
QUEEN CREEK AZ
85142-1325
US

V. Phone/Fax

Practice location:
  • Phone: 602-457-4320
  • Fax:
Mailing address:
  • Phone: 513-403-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS023277
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017803
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03334886
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: