Provider Demographics
NPI:1679592646
Name:OAKWOOD VILLAGE UNIVERSITY WOODS HOMES, INC
Entity type:Organization
Organization Name:OAKWOOD VILLAGE UNIVERSITY WOODS HOMES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STUDNICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-230-4404
Mailing Address - Street 1:6165 MINERAL POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4457
Mailing Address - Country:US
Mailing Address - Phone:608-230-4217
Mailing Address - Fax:608-230-4327
Practice Address - Street 1:6165 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4457
Practice Address - Country:US
Practice Address - Phone:608-230-4217
Practice Address - Fax:608-230-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
WI68300423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114770OtherPK
WI3312250Medicaid
4651950001Medicare NSC