1952610693 NPI number — AURORA PHARMACY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952610693 NPI number — AURORA PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AURORA PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952610693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
975 PORT WASHINGTON ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GRAFTON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53024-9201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-803-3266
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 PORT WASHINGTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GRAFTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53024-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-803-3266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PANTEL
Authorized Official First Name:
MARY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
920-803-3266

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  9034-042 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5132369 . This is a "NCPDP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1952610693 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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