Active NPI
Roanoke RX LLC
- Community/Retail Pharmacy
- Roanoke, IL
National Provider Identifier
1104302249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- ROANOKE RX LLC
- Practice address
- 322 N Main St
Roanoke, IL 61561-7515 - Phone
- (309) 923-7711
- Fax
- (309) 923-7714
- NPI assigned
- Jul 12, 2018
- Organization subpart
- Yes
- Parent organization
- ROANOKE RX LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Troy Williams, RPH
- Title
- RPH/Owner
- Phone
- (309) 660-5939
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 054020855 | IL | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
322 N Main St
Roanoke, IL 61561-7515
Mailing address
PO Box 1087
Bloomington, IL 61702-1087
Phone (309) 828-6767
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1494450 | Other | IL | NCPDP |
Other names 1
- Axline Pharmacy 03
National Provider Directory
National Provider Directory- Part of
- Roanoke RX LLC
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Bloomington, IL
- NPI 1760099899
-
- Pharmacist
- Monmouth, IL
- NPI 1528675659
-
- Pharmacist
- Normal, IL
- NPI 1154308047
-
- Pharmacist
- Bloomington, IL
- NPI 1730049131
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531353600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1647388800000",
"number": "1104302249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1087",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617021087",
"telephone_number": "309-828-6767",
"fax_number": "309-828-6970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "322 N MAIN ST",
"city": "ROANOKE",
"state": "IL",
"postal_code": "615617515",
"telephone_number": "309-923-7711",
"fax_number": "309-923-7714"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROANOKE RX LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ROANOKE RX LLC",
"enumeration_date": "2018-07-12",
"last_updated": "2022-03-16",
"certification_date": "2022-03-16",
"status": "A",
"authorized_official_last_name": "WILLIAMS",
"authorized_official_first_name": "TROY",
"authorized_official_title_or_position": "RPH/OWNER",
"authorized_official_telephone_number": "309-660-5939",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "IL",
"license": "054020855",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "1494450",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Axline Pharmacy 03",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Roanoke, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.