Provider Demographics
NPI:1497063895
Name:AURORA PHARMACY, INC.
Entity Type:Organization
Organization Name:AURORA PHARMACY, INC.
Other - Org Name:AURORA SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REV CYCLE ANALYST SR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-803-3266
Mailing Address - Street 1:N93W14575 WHITTAKER WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-1652
Mailing Address - Country:US
Mailing Address - Phone:262-253-3000
Mailing Address - Fax:262-253-3001
Practice Address - Street 1:N93W14575 WHITTAKER WAY STE 100
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-1652
Practice Address - Country:US
Practice Address - Phone:262-253-3000
Practice Address - Fax:262-253-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9438333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1497063895Medicaid
WI5132357OtherNCPDP
WI5132357OtherNCPDP