Organization Active NPI

Aurora Pharmacy Inc

Doing business as Aurora Pharmacy

  • Pharmacy
  • Appleton, WI
National Provider Identifier
1679507891
Registry record updated Jan 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
8083 Issued in WI
Legal business name
AURORA PHARMACY INC
Doing business as
Aurora Pharmacy
Practice address
2400 W Wisconsin Ave
Appleton, WI 54914-3109
Phone
(920) 831-0400
Fax
(920) 831-0322
NPI assigned
Jul 11, 2006
Last updated
Jan 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joanne Thede
Title
Billing Manager
Phone
(920) 803-3263

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 8083 WI Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

2400 W Wisconsin Ave
Appleton, WI 54914-3109

Mailing address

2400 W Wisconsin Ave
Appleton, WI 54914-3109

Other identifiers 2

IdentifierTypeStateIssuer
5126506OtherOTHER ID NUMBER-COMMERCIAL NUMBER
33256400MedicaidWI

Other names 1

  • AURORA PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040202000666 WI Part B Supplier - Mass Immunization (Roster Biller Only) 3577466820 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory

Locations

2400 W Wisconsin Ave
Grand Chute, WI 54914
Phone (920) 739-0934

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201219200000",
    "number": "1679507891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 W WISCONSIN AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 W WISCONSIN AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143109",
            "telephone_number": "920-831-0400",
            "fax_number": "920-831-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AURORA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2008-01-25",
        "status": "A",
        "authorized_official_last_name": "THEDE",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "920-803-3263"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "8083",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5126506",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33256400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AURORA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.