Provider Demographics
NPI:1568096212
Name:RUONA, PATRICE I (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:RUONA
Suffix:I
Gender:F
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:W165N5595 CREEKWOOD XING
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0685
Mailing Address - Country:US
Mailing Address - Phone:262-703-3386
Mailing Address - Fax:262-252-4807
Practice Address - Street 1:W165N5595 CREEKWOOD XING
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0685
Practice Address - Country:US
Practice Address - Phone:262-703-3386
Practice Address - Fax:262-252-4807
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11916-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist