Provider Demographics
NPI:1336436559
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:OPERATIONAL IMPROVEMENT SPECIALIST
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 1:2219 GARFIELD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-2416
Mailing Address - Country:US
Mailing Address - Phone:920-794-8029
Mailing Address - Fax:920-794-8070
Practice Address - Street 1:2219 GARFIELD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-2416
Practice Address - Country:US
Practice Address - Phone:920-794-8029
Practice Address - Fax:920-794-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93953336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1235163452Medicaid
WI5132698OtherNCPDP
WI5132698OtherNCPDP