Provider Demographics
NPI:1083772297
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 1:1303 STATE ROAD 175
Mailing Address - Street 2:
Mailing Address - City:HUBERTUS
Mailing Address - State:WI
Mailing Address - Zip Code:53033-9304
Mailing Address - Country:US
Mailing Address - Phone:262-628-3550
Mailing Address - Fax:262-628-9205
Practice Address - Street 1:3055 HUBERTUS RD STE 100
Practice Address - Street 2:
Practice Address - City:HUBERTUS
Practice Address - State:WI
Practice Address - Zip Code:53033-9316
Practice Address - Country:US
Practice Address - Phone:262-628-3550
Practice Address - Fax:262-628-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5129603OtherNCPDP
WI33294200Medicaid
WI0532850183Medicare NSC
WIP00115671Medicare PIN
WI33294200Medicaid