# ROANOKE RX LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ROANOKE RX LLC
- **Other names:** Axline Pharmacy 03
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104302249
- **Legal business name:** ROANOKE RX LLC
- **Authorized official:** TROY WILLIAMS RPH (RPH/OWNER)
- **Authorized official phone:** (309) 660-5939

## Contact information

- **Practice address:** 322 N MAIN ST, ROANOKE, IL 61561-7515
- **Practice address phone:** (309) 923-7711
- **Practice address fax:** (309) 923-7714
- **Mailing address:** PO BOX 1087, BLOOMINGTON, IL 61702-1087
- **Mailing address phone:** (309) 828-6767
- **Mailing address fax:** (309) 828-6970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 054020855 | IL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 07/12/2018
- **Last updated:** 03/16/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1494450 | NCPDP | IL |