Organization
AXLINE'S INC.
Active
Other names
Axline Pharmacy (05)
Organization subpart
No
Provider details
NPI number
Authorized official
TROY WILLIAMS RPH (OWNER/PRESIDENT)
(309) 828-6767
Entity
Organization
Contact information
Practice address
1210 TOWANDA AVE STE 11, BLOOMINGTON, IL 61701-7415
(309) 828-6767
(309) 828-6970
Mailing address
PO BOX 1087, BLOOMINGTON, IL 61702-1087
(309) 828-6767
(309) 828-6970
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054018166
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487772
NCPDP
IL
Enumeration date
03/07/2013
Last updated
03/16/2022
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