Healthcare Provider Details

I. General information

NPI: 1063437796
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: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 S HOWELL AVE SUITE 3
OAK CREEK WI
53154-7524
US

IV. Provider business mailing address

8770 S HOWELL AVE SUITE 3
OAK CREEK WI
53154-7524
US

V. Phone/Fax

Practice location:
  • Phone: 414-762-6770
  • Fax: 414-571-4125
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7627
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARY PANTEL
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 920-803-3266