Provider Demographics
NPI:1003085952
Name:WODICKA, RAYMOND ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ALAN
Last Name:WODICKA
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 1:2110 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1025
Mailing Address - Country:US
Mailing Address - Phone:303-238-8781
Mailing Address - Fax:
Practice Address - Street 1:2110 WILLOW LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1025
Practice Address - Country:US
Practice Address - Phone:303-547-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist