Provider Demographics
NPI:1962837922
Name:WOODRUFF, BENJAMIN KEVIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:KEVIN
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:KEVIN
Other - Last Name:WOODRUFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:30225 W CHEERY LYNN RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-3173
Mailing Address - Country:US
Mailing Address - Phone:623-810-6720
Mailing Address - Fax:
Practice Address - Street 1:16380 W YUMA RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3100
Practice Address - Country:US
Practice Address - Phone:623-925-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist