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General NPI Number Information
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NPI Number | 1821781113
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Entity Type | Individual
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Provider Name | KENNETH SCOTT WOODALL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 23056 E CAMINA BUENA VIS
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-1325
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Country | US
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Telephone | 513-403-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 23056 E CAMINA BUENA VIS
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-1325
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Country | US
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Telephone | 513-403-3170
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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 | 017803
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03334886
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S023277
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License Number State | AZ
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