Healthcare Provider Details

I. General information

NPI: 1881603694
Provider Name (Legal Business Name): JOHN RUONA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 N GREEN BAY RD
BROWN DEER WI
53209-1104
US

IV. Provider business mailing address

1925 FIELD CLIFFE DR
RICHFIELD WI
53076
US

V. Phone/Fax

Practice location:
  • Phone: 414-354-7213
  • Fax: 414-354-7932
Mailing address:
  • Phone: 262-628-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11602040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: