=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336634229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AURORA PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2018
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3003 UNIVERSITY DR STE 1
-----------------------------------------------------
City | MARINETTE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54143-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-735-4689
-----------------------------------------------------
Fax | 715-735-4685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 SUPERIOR AVE
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-2855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-803-3266
-----------------------------------------------------
Fax | 920-459-2634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP MANAGED HEALTH
-----------------------------------------------------
Name | KARA RICHARDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-631-0450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------