Healthcare Provider Details

I. General information

NPI: 1952335176
Provider Name (Legal Business Name): AURORA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 N SPRING ST
BEAVER DAM WI
53916-1194
US

IV. Provider business mailing address

PO BOX 208
SHEBOYGAN WI
53082-0208
US

V. Phone/Fax

Practice location:
  • Phone: 920-887-3187
  • Fax: 920-887-9383
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8704
License Number StateWI

VIII. Authorized Official

Name: JOANNE THEDE
Title or Position: PATIENT FINANCIAL SRVS MGR
Credential:
Phone: 920-803-3263