Healthcare Provider Details

I. General information

NPI: 1558395772
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: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MEMORIAL DR SUITE 103
TWO RIVERS WI
54241-3923
US

IV. Provider business mailing address

5300 MEMORIAL DR SUITE 103
TWO RIVERS WI
54241-3923
US

V. Phone/Fax

Practice location:
  • Phone: 920-793-7380
  • Fax: 920-793-7381
Mailing address:
  • Phone: 920-793-7380
  • Fax: 920-793-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8521
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KARA RICHARDSON
Title or Position: VP MANAGED HEALTH
Credential:
Phone: 704-631-0450