Healthcare Provider Details

I. General information

NPI: 1306017942
Provider Name (Legal Business Name): AURORA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W GOOD HOPE RD SUITE 1129
MILWAUKEE WI
53209-2042
US

IV. Provider business mailing address

3003 W GOOD HOPE RD SUITE 1129
MILWAUKEE WI
53209-2042
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-9236
  • Fax: 414-540-9347
Mailing address:
  • Phone: 414-540-9236
  • Fax: 414-540-9347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8814
License Number StateWI

VIII. Authorized Official

Name: MARY R PANTEL
Title or Position: PATIENT FINANCIAL SERVICES SUPERVIS
Credential:
Phone: 920-803-3266