Healthcare Provider Details

I. General information

NPI: 1336436559
Provider Name (Legal Business Name): AURORA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 GARFIELD ST SUITE 100
TWO RIVERS WI
54241-2416
US

IV. Provider business mailing address

2219 GARFIELD ST STE 100
TWO RIVERS WI
54241-2416
US

V. Phone/Fax

Practice location:
  • Phone: 920-794-8029
  • Fax: 920-794-8070
Mailing address:
  • Phone: 920-794-8029
  • Fax: 920-794-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number9395
License Number StateWI

VIII. Authorized Official

Name: MARY R PANTEL
Title or Position: REVENUE CYCLE ANALYST SR.
Credential:
Phone: 920-803-3266