Healthcare Provider Details

I. General information

NPI: 1336171339
Provider Name (Legal Business Name): AURORA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25320 75TH ST
PADDOCK LAKE WI
53168
US

IV. Provider business mailing address

25320 75TH ST.
PADDOCK LAKE WI
53168
US

V. Phone/Fax

Practice location:
  • Phone: 262-843-2373
  • Fax: 262-843-4163
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8548
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