Aurora Pharmacy Inc
Organization Active NPI Pharmacy · Kenosha, WI
NPI 1366476582 · NPPES record last updated Feb 4, 2025
Key facts
- NPI
- 1366476582
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 7400 (WI)
- Legal business name
- AURORA PHARMACY INC
- Practice address
- 10400 75TH St
Kenosha, WI 53142-7884 - Phone
- (262) 948-7040
- Fax
- (262) 948-7330
- NPI assigned
- Jul 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Kara Richardson
- Title
- VP Managed Health
- Phone
- (704) 631-0450
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Aurora Pharmacy Inc |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040202000666 | WI | Part B Supplier - Mass Immunization (Roster Biller Only) | 3577466820 | This NPI is an additional NPI on the enrollment |
| O20100930052149 | WI | DME Supplier - Pharmacy | 3577466820 | Practice locations: Kenosha, WI |
National Provider Directory
- Tax ID family
- Aurora Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 7400 | WI | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
10400 75TH St
Kenosha, WI 53142-7884
Mailing address
10400 75TH St
Kenosha, WI 53142-7884
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33201600 | Medicaid | WI | |
| 5122089 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 000086609 | Other | WI | MEDICARE IMMUNIZATION |
Other names
- AURORA PHARMACY
Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.