Provider Demographics
NPI:1912354150
Name:AURORA PHARMACY INC
Entity type:Organization
Organization Name:AURORA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-631-0450
Mailing Address - Street 1:700 N LAKE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9436
Mailing Address - Country:US
Mailing Address - Phone:262-877-8777
Mailing Address - Fax:262-877-3730
Practice Address - Street 1:700 N LAKE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9436
Practice Address - Country:US
Practice Address - Phone:262-877-8777
Practice Address - Fax:262-877-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93953336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5135303OtherNCPDP