Healthcare Provider Details

I. General information

NPI: 1639194368
Provider Name (Legal Business Name): AURORA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
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:
  • 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 Code3336C0002X
TaxonomyClinic Pharmacy
License Number9395
License Number StateWI

VIII. Authorized Official

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