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General NPI Number Information
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NPI Number | 1003914128
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Entity Type | Individual
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Provider Name | KENNETH EUGENE GUDGEL R.PH.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9329 E MONTGOMERY AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4295
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Country | US
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Telephone | 509-343-3379
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Fax | 509-242-1764
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Provider Business Mailing Address
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Address Line | 8104 E MARINGO DR
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City | SPOKANE
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State | WA
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Zip | 99212-1859
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Country | US
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Telephone | 509-710-2866
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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 | PH00010224
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License Number State | WA
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