Provider Demographics
NPI:1962436188
Name:AURORA PHARMACY INC
Entity type:Organization
Organization Name:AURORA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONAL IMPROVEMENT SPECIALIST
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 1:525 KENOSHA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WALWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:53184-9512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 KENOSHA ST
Practice Address - Street 2:SUITE C
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184-9512
Practice Address - Country:US
Practice Address - Phone:262-275-0936
Practice Address - Fax:262-275-0953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93953336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316971534Medicaid
5125213OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5125213OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WI000086609Medicare PIN
WI0532850076Medicare NSC