Provider Demographics
NPI:1164064085
Name:AURORA PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:AURORA PROFESSIONAL PHARMACY INC
Other - Org Name:AURORA PROFESSIONAL PHARMACY-NH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-678-4136
Mailing Address - Street 1:212 S ELLIOTT AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-1631
Mailing Address - Country:US
Mailing Address - Phone:417-678-4136
Mailing Address - Fax:417-678-2014
Practice Address - Street 1:124 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-1427
Practice Address - Country:US
Practice Address - Phone:417-678-4136
Practice Address - Fax:417-678-2014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AURORA PROFESSIONAL PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-11
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600282800Medicaid