Healthcare Provider Details

I. General information

NPI: 1124153929
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

123 W OKLAHOMA AVE
MILWAUKEE WI
53207-2640
US

IV. Provider business mailing address

123 W OKLAHOMA AVE
MILWAUKEE WI
53207-2640
US

V. Phone/Fax

Practice location:
  • Phone: 414-482-2406
  • Fax: 414-482-2904
Mailing address:
  • Phone: 414-482-2406
  • Fax: 414-482-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8727
License Number StateWI

VIII. Authorized Official

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