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	333600000X	Pharmacy	8724	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	5129867	OTHER	WI	NCPDP

General Provider Information

NPI Number	:	1902931702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA PHARMACY, INC.

Provider Business Mailing Address
First Line	:	5740 WASHINGTON AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-4018
Country	:	US
Telephone Number	:	262-619-1162
Fax Number	:	262-619-1196

Provider Business Practice Location Address
First Line	:	5740 WASHINGTON AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-4018
Country	:	US
Telephone Number	:	262-619-1162
Fax Number	:	262-619-1196

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	01/25/2008

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