Provider Demographics
NPI:1942586565
Name:HODKIEWICZ, ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:HODKIEWICZ
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 1:3710 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3647
Mailing Address - Country:US
Mailing Address - Phone:608-242-9483
Mailing Address - Fax:608-242-9554
Practice Address - Street 1:3710 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3647
Practice Address - Country:US
Practice Address - Phone:608-242-9483
Practice Address - Fax:608-242-9554
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10178-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist