MEDICARE: AURORA PROFESSIONAL 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	3336L0003X	Long Term Care Pharmacy

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

General Provider Information

NPI Number	:	1164064085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA PROFESSIONAL PHARMACY INC

Provider Business Mailing Address
First Line	:	212 S ELLIOTT AVE
Second Line	:
City	:	AURORA
State	:	MO
Zip	:	65605-1631
Country	:	US
Telephone Number	:	417-678-4136
Fax Number	:	417-678-2014

Provider Business Practice Location Address
First Line	:	124 S MADISON AVE
Second Line	:
City	:	AURORA
State	:	MO
Zip	:	65605-1427
Country	:	US
Telephone Number	:	417-678-4136
Fax Number	:	417-678-2014

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN L MCCLANAHAN
Credential	:
Telephone Number	:	417-735-0055

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	02/26/2025

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