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NPI Code Detail

MEDICARE: AURORA PHARMACY INC

MEDICARE: AURORA PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacy8051WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15126291OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306870522
Entity Type Code : Organization
Provider Name (Legal Business Name) : AURORA PHARMACY INC
Provider Business Mailing Address
First Line : 1475 W GRAND AVE
Second Line :
City : PORT WASHINGTON
State : WI
Zip : 53074-2074
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1475 W GRAND AVE
Second Line :
City : PORT WASHINGTON
State : WI
Zip : 53074-2074
Country : US
Telephone Number : 262-268-5140
Fax Number : 262-268-5144
Authorized Official
Title or Position : BILLING MANAGER
Name : JOANNE THEDE
Credential :
Telephone Number : 920-803-3263
Provider Enumeration Date : 07/11/2006
Last Update Date : 01/21/2008

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Directions to “AURORA PHARMACY INC ” Practice Location

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