MEDICARE: AURORA PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	8406	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5127938	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1386678506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA PHARMACY INC

Provider Business Mailing Address
First Line	:	203 N MAIN ST
Second Line	:
City	:	LAKE MILLS
State	:	WI
Zip	:	53551-1610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 N MAIN ST
Second Line	:
City	:	LAKE MILLS
State	:	WI
Zip	:	53551-1610
Country	:	US
Telephone Number	:	920-648-3455
Fax Number	:	920-648-2712

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/22/2008

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Directions to “AURORA PHARMACY INC ” Practice Location

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