Aurora Pharmacy, Inc.
Organization Active NPI Pharmacy · Racine, WI
NPI 1902931702 · NPPES record last updated Jan 25, 2008
Key facts
- NPI
- 1902931702
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 8724 (WI)
- Legal business name
- AURORA PHARMACY, INC.
- Practice address
- 5740 Washington Ave
Racine, WI 53406-4018 - Phone
- (262) 619-1162
- Fax
- (262) 619-1196
- NPI assigned
- Feb 22, 2007
- Organization subpart
- No
Authorized official
- Name
- Joanne A 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 8724 | WI | Yes |
Addresses
Primary practice location
5740 Washington Ave
Racine, WI 53406-4018
Mailing address
5740 Washington Ave
Racine, WI 53406-4018
Phone (262) 619-1162
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33297400 | Medicaid | WI | |
| 5129867 | Other | WI | NCPDP |
Other names
- Aurora Pharmacy
Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 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.