Provider Demographics
NPI:1740402585
Name:WOFFORD, KENNETH MILLER
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MILLER
Last Name:WOFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MOUNTAIN BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-6414
Mailing Address - Country:US
Mailing Address - Phone:864-246-2090
Mailing Address - Fax:
Practice Address - Street 1:7 MOUNTAIN BROOK TRL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-6414
Practice Address - Country:US
Practice Address - Phone:864-246-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1267070001Medicare ID - Type Unspecified