Healthcare Provider Details

I. General information

NPI: 1003914128
Provider Name (Legal Business Name): KENNETH EUGENE GUDGEL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9329 E MONTGOMERY AVE
SPOKANE VALLEY WA
99206-4295
US

IV. Provider business mailing address

8104 E MARINGO DR
SPOKANE WA
99212-1859
US

V. Phone/Fax

Practice location:
  • Phone: 509-343-3379
  • Fax: 509-242-1764
Mailing address:
  • Phone: 509-710-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00010224
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: