Healthcare Provider Details

I. General information

NPI: 1639237019
Provider Name (Legal Business Name): AURORA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 GRAND VIEW AVENUE SUITE 1
CAMPBELLSPORT WI
53010
US

IV. Provider business mailing address

470 GRAND VIEW AVENUE SUITE 1
CAMPBELLSPORT WI
53010
US

V. Phone/Fax

Practice location:
  • Phone: 920-533-3970
  • Fax: 920-533-3971
Mailing address:
  • Phone: 920-533-3970
  • Fax: 920-533-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number8697
License Number StateWI

VIII. Authorized Official

Name: JOANNE THEDE
Title or Position: BILLING MANAGER
Credential:
Phone: 920-803-3263