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Organization
ROANOKE RX LLC
Active
Organization
ROANOKE RX LLC
Active
Parent organization
ROANOKE RX LLC
Other names
Axline Pharmacy 03
Organization subpart
Yes
Provider details
NPI number
Legal business name
ROANOKE RX LLC
Authorized official
TROY WILLIAMS RPH (RPH/OWNER)
(309) 660-5939
Entity
Organization
Contact information
Practice address
322 N MAIN ST, ROANOKE, IL 61561-7515
(309) 923-7711
(309) 923-7714
Mailing address
PO BOX 1087, BLOOMINGTON, IL 61702-1087
(309) 828-6767
(309) 828-6970
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
054020855
IL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1494450
NCPDP
IL
Enumeration date
07/12/2018
Last updated
03/16/2022
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