Provider Demographics
NPI:1881603694
Name:RUONA, JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:RUONA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 FIELD CLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53076
Mailing Address - Country:US
Mailing Address - Phone:262-628-3305
Mailing Address - Fax:
Practice Address - Street 1:9200 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1104
Practice Address - Country:US
Practice Address - Phone:414-354-7213
Practice Address - Fax:414-354-7932
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11602040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist