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General NPI Number Information
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NPI Number | 1376593483
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Entity Type | Organization
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Legal Business Name | AXLINE'S INC.
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 116 S MAIN ST
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City | FLANAGAN
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State | IL
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Zip | 61740-7536
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Country | US
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Telephone | 815-796-2274
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Fax | 815-796-3277
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Provider Business Mailing Address
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Address Line | PO BOX 1087
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City | BLOOMINGTON
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State | IL
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Zip | 61702-1087
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Country | US
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Telephone | 309-828-6767
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Fax | 309-828-6978
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Authorized Official
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Title or Position | OWNER/RPH
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Name | TROY WILLIAMS
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Credential |
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Telephone | 309-828-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054-018165
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License Number State | IL
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