MEDICARE: AURORA PHARMACY INC

Medicare Provider Information

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	7663	WI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5123562	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

NPI Number	:	1164456380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA PHARMACY INC

Provider Business Mailing Address
First Line	:	205 VALLEY AVE
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-5312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 VALLEY AVE
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-5312
Country	:	US
Telephone Number	:	262-338-2311
Fax Number	:	262-338-2262

Authorized Official
Title or Position	:	VP MANAGED HEALTH
Name	:	KARA RICHARDSON
Credential	:
Telephone Number	:	704-631-0450

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/30/2025

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308