Provider Demographics
NPI:1609865047
Name:AURORA PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:AURORA PROFESSIONAL PHARMACY INC
Other - Org Name:AURORA PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:BS ACCOUNTING
Authorized Official - Phone:417-678-2260
Mailing Address - Street 1:124 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-1427
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO0046613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600282800Medicaid
2047700OtherPK