Healthcare Provider Details

I. General information

NPI: 1093840886
Provider Name (Legal Business Name): AURORA PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7014 GREEN BAY RD
KENOSHA WI
53142-1435
US

IV. Provider business mailing address

7014 GREEN BAY RD
KENOSHA WI
53142-1435
US

V. Phone/Fax

Practice location:
  • Phone: 262-697-8615
  • Fax: 262-697-8698
Mailing address:
  • Phone: 262-697-8615
  • Fax: 262-697-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8726
License Number StateWI

VIII. Authorized Official

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