NPIMap

Organization Active NPI

Axline Advanced

  • Long Term Care Pharmacy
  • Bloomington, IL
National Provider Identifier
1215237359
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
054-017559 Issued in IL
Legal business name
AXLINE ADVANCED
Practice address
1210 Towanda Ave
Unit 10
Bloomington, IL 61701-3454
Phone
(309) 828-6979
Fax
(309) 828-6977
NPI assigned
Oct 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Daniel Paul Duncan
Title
Operations Manager
Phone
(309) 828-6979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X 054-017559 IL Primary

Addresses

Primary practice location

1210 Towanda Ave
Unit 10
Bloomington, IL 61701-3454

Mailing address

1210 Towanda Ave Ste 10
PO Box 1087
Bloomington, IL 61701-7415
Phone (309) 828-6979

Other identifiers 2

IdentifierTypeStateIssuer
054-017559OtherILILLINOIS LICENSE
1484978OtherILNCPDP

National Provider Directory

National Provider Directory
Tax ID family
Axlines Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1210 Towanda Ave
Ste 10
Bloomington, IL 61701
Phone (309) 828-6979

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1215237359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 TOWANDA AVE STE 10",
            "address_2": "PO BOX 1087",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017415",
            "telephone_number": "309-828-6979",
            "fax_number": "309-828-6977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 TOWANDA AVE",
            "address_2": "UNIT 10",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013454",
            "telephone_number": "309-828-6979",
            "fax_number": "309-828-6977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXLINE ADVANCED",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-22",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "309-828-6979",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IL",
            "license": "054-017559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS LICENSE",
            "identifier": "054-017559",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1484978",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, 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.

Verify at the official NPI Registry.