MEDICARE: AURORA PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	7833	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5124805	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1417981630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA PHARMACY INC

Provider Business Mailing Address
First Line	:	2927 N 15TH ST
Second Line	:	SUITE 100
City	:	SHEBOYGAN
State	:	WI
Zip	:	53083-3946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2927 N 15TH ST
Second Line	:	SUITE 100
City	:	SHEBOYGAN
State	:	WI
Zip	:	53083-3946
Country	:	US
Telephone Number	:	920-458-4348
Fax Number	:	920-451-8307

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MARY PANTEL
Credential	:
Telephone Number	:	920-803-3266

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	12/22/2010

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Directions to “AURORA PHARMACY INC ” Practice Location

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