Provider Demographics
NPI:1104425784
Name:FOO, SEANG
Entity type:Individual
Prefix:MR
First Name:SEANG
Middle Name:
Last Name:FOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 E WISCONSIN AVE # MS 2870
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5404
Mailing Address - Country:US
Mailing Address - Phone:404-784-6988
Mailing Address - Fax:
Practice Address - Street 1:875 E WISCONSIN AVE # MS 2870
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5404
Practice Address - Country:US
Practice Address - Phone:404-784-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0513031201835P0018X
IL051.303120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist