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General NPI Number Information
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NPI Number | 1639194368
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Entity Type | Organization
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Legal Business Name | AURORA PHARMACY INC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 620 S WISCONSIN DR
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City | HOWARDS GROVE
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State | WI
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Zip | 53083-1263
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Country | US
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Telephone | 920-565-5425
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Fax | 920-565-4477
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Provider Business Mailing Address
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Address Line | 620 S WISCONSIN DR
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City | HOWARDS GROVE
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State | WI
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Zip | 53083-1263
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JOANNE THEDE
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Credential |
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Telephone | 920-803-3263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 9395
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License Number State | WI
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