Provider Demographics
NPI:1720012941
Name:AURORA SINAI MEDICAL
Entity Type:Organization
Organization Name:AURORA SINAI MEDICAL
Other - Org Name:JOHNSTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOERENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-803-3260
Mailing Address - Street 1:1230 W GRANT ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1230 W GRANT ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2732
Practice Address - Country:US
Practice Address - Phone:414-672-5147
Practice Address - Fax:414-384-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69923336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5118282OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WI32955300Medicaid