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General NPI Number Information
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NPI Number | 1952610693
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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 | 09/29/2010
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 975 PORT WASHINGTON ROAD SUITE 100
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City | GRAFTON
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State | WI
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Zip | 53024-9201
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Country | US
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Telephone | 920-803-3266
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Fax |
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Provider Business Mailing Address
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Address Line | 975 PORT WASHINGTON ROAD SUITE 100
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City | GRAFTON
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State | WI
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Zip | 53024-9201
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Country | US
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Telephone | 920-803-3266
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Fax |
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MARY R PANTEL
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Credential |
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Telephone | 920-803-3266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 9034-042
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License Number State | WI
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