Healthcare Provider Details

I. General information

NPI: 1184021966
Provider Name (Legal Business Name): SEA KAN ONG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2014
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N95W18351 COUNTY LINE RD
MENOMONEE FALLS WI
53051-1335
US

IV. Provider business mailing address

N95W18351 COUNTY LINE RD
MENOMONEE FALLS WI
53051-1335
US

V. Phone/Fax

Practice location:
  • Phone: 262-253-4705
  • Fax: 262-253-4854
Mailing address:
  • Phone: 262-253-4705
  • Fax: 262-253-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11765-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: