Healthcare Provider Details

I. General information

NPI: 1992739114
Provider Name (Legal Business Name): AURORA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6462 S. 27TH ST.
OAK CREEK WI
53154-1015
US

IV. Provider business mailing address

6462 S. 27TH ST.
OAK CREEK WI
53154-1015
US

V. Phone/Fax

Practice location:
  • Phone: 414-761-1550
  • Fax: 414-761-1682
Mailing address:
  • Phone: 414-761-1550
  • Fax: 414-761-1682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8321
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: PATIENT FINANCIAL SERVICES SUPERVIS
Credential:
Phone: 920-803-3266