Healthcare Provider Details

I. General information

NPI: 1174558134
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: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W231N1440 CORPORATE CT
WAUKESHA WI
53186-1303
US

IV. Provider business mailing address

W231N1440 CORPORATE CT
WAUKESHA WI
53186-1303
US

V. Phone/Fax

Practice location:
  • Phone: 262-896-6040
  • Fax: 262-896-6129
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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