Healthcare Provider Details

I. General information

NPI: 1083649040
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: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W320 S 1807B STATE RD 83
WALES WI
53183
US

IV. Provider business mailing address

W320 S 1807B STATE RD 83
WALES WI
53183
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-9570
  • Fax: 262-968-9574
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number7667
License Number StateWI

VIII. Authorized Official

Name: JOANNE THEDE
Title or Position: BILLING MANAGER
Credential:
Phone: 920-803-3263