1467549287 NPI number — AURORA PHARMACY INC.

Table of content: (NPI 1467549287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467549287 NPI number — AURORA PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA PHARMACY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467549287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 EAST AVENUE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
LOMIRA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-269-2080
Provider Business Mailing Address Fax Number:
920-269-2081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 EAST AVENUE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LOMIRA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-269-2080
Provider Business Practice Location Address Fax Number:
920-269-2081
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  9395 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518991736 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5129463 . This is a "NCPDP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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