Provider Demographics
NPI:1407272792
Name:AURORA PHARMACY INC.
Entity Type:Organization
Organization Name:AURORA PHARMACY INC.
Other - Org Name:AURORA PRESCRIPTION DISPENSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-803-3266
Mailing Address - Street 1:16985 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5946
Mailing Address - Country:US
Mailing Address - Phone:262-641-7665
Mailing Address - Fax:262-784-3977
Practice Address - Street 1:16985 W BLUEMOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5946
Practice Address - Country:US
Practice Address - Phone:262-641-7665
Practice Address - Fax:262-784-3977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93953336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487095287Medicaid
0532850204Medicare NSC