Aurora Pharmacy Inc
Organization Active NPI Pharmacy · West Milwaukee, WI
NPI 1720003452 · NPPES record last updated Jan 21, 2008
Key facts
- NPI
- 1720003452
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 8303 (WI)
- Legal business name
- AURORA PHARMACY INC
- Practice address
- 1138 Miller Park Way
West Milwaukee, WI 53214-3653 - Phone
- (414) 389-1196
- Fax
- (414) 389-1304
- NPI assigned
- Jul 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Joanne Thede
- Title
- Billing Manager
- Phone
- (920) 803-3263
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled 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 |
National Provider Directory
Locations
1138 Miller Park Way
West Milwaukee, WI 53214
Phone (414) 389-1196
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 8303 | WI | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1138 Miller Park Way
West Milwaukee, WI 53214-3653
Mailing address
1138 Miller Park Way
West Milwaukee, WI 53214-3653
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33268400 | Medicaid | WI | |
| 5127370 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names
- AURORA PHARMACY
Other providers in West Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2008. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.