Healthcare Provider Details

I. General information

NPI: 1386068179
Provider Name (Legal Business Name): AURORA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S WISCONSIN DR
HOWARDS GROVE WI
53083-1263
US

IV. Provider business mailing address

620 S WISCONSIN DR
HOWARDS GROVE WI
53083-1263
US

V. Phone/Fax

Practice location:
  • Phone: 920-565-5425
  • Fax: 920-565-4477
Mailing address:
  • Phone: 920-565-5425
  • Fax: 920-565-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10770
License Number StateWI

VIII. Authorized Official

Name: ROBERT L ADAMS
Title or Position: MANAGING PHARMACIST
Credential: RPH
Phone: 920-565-5425