Provider Demographics
NPI:1003914128
Name:GUDGEL, KENNETH EUGENE (RPH)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:GUDGEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8104 E MARINGO DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1859
Mailing Address - Country:US
Mailing Address - Phone:509-710-2866
Mailing Address - Fax:
Practice Address - Street 1:9329 E MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4295
Practice Address - Country:US
Practice Address - Phone:509-343-3379
Practice Address - Fax:509-242-1764
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist