1679529663 NPI number — AURORA PHARMACY, INC.

Table of content: (NPI 1679529663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679529663 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 PRESCRIPTION DISPENSING CENTER
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:
1679529663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 FORREST DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53185-4577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-514-8050
Provider Business Mailing Address Fax Number:
262-514-8151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 FORREST DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53185-4577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-514-8050
Provider Business Practice Location Address Fax Number:
262-514-8151
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THEDE
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
920-803-3263

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  9395 , 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: 000086609 . This is a "MEDICARE IMMUNIZATION" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1861426082 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5129184 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com