Healthcare Provider Details

I. General information

NPI: 1376568006
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: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W GRANGE AVE
MILWAUKEE WI
53207-6030
US

IV. Provider business mailing address

180 W GRANGE AVE
MILWAUKEE WI
53207-6030
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-4302
  • Fax: 414-489-0126
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