Provider Demographics
NPI:1326147497
Name:WODICKA, SONYA REAGIN (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:REAGIN
Last Name:WODICKA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-4206
Mailing Address - Country:US
Mailing Address - Phone:434-384-1985
Mailing Address - Fax:
Practice Address - Street 1:521 COLONY RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2105
Practice Address - Country:US
Practice Address - Phone:434-947-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist