Provider Demographics
NPI:1871178012
Name:SUDOL, KENNETH MARK (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MARK
Last Name:SUDOL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:MARK
Other - Last Name:SUDOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1650 COCHRANE CIR UNIT MEDDAC
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-524-4400
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR UNIT MEDDAC
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-524-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035497L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist