MEDICARE: MR. RAYMOND ALAN WODICKA R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10014	CO

General Provider Information

NPI Number	:	1003085952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND ALAN WODICKA R.PH.

Provider Business Mailing Address
First Line	:	2110 WILLOW LN
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1025
Country	:	US
Telephone Number	:	303-238-8781
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 WILLOW LN
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1025
Country	:	US
Telephone Number	:	303-547-6010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/09/2011

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