Provider Demographics
NPI:1649217878
Name:AURORA PHARMACY, INC.
Entity Type:Organization
Organization Name:AURORA PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOERENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-803-3260
Mailing Address - Street 1:65 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-1531
Mailing Address - Country:US
Mailing Address - Phone:262-673-2890
Mailing Address - Fax:262-673-9519
Practice Address - Street 1:65 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1531
Practice Address - Country:US
Practice Address - Phone:262-673-2890
Practice Address - Fax:262-673-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI76543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33220600Medicaid