Provider Demographics
NPI:1689346447
Name:MOUA, KONGYENG SEAVER (PHARMD)
Entity Type:Individual
Prefix:
First Name:KONGYENG
Middle Name:SEAVER
Last Name:MOUA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:SEAVER
Other - Middle Name:
Other - Last Name:MOUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2050 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3856
Mailing Address - Country:US
Mailing Address - Phone:248-652-4229
Mailing Address - Fax:
Practice Address - Street 1:2050 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3856
Practice Address - Country:US
Practice Address - Phone:248-601-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist