NPIMap

Organization Active NPI

Axline's Inc.

Doing business as Axline Pharmacy

  • Community/Retail Pharmacy
  • Granville, IL
National Provider Identifier
1407286941
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
AXLINE'S INC.
Doing business as
Axline Pharmacy
Practice address
324 S. McCoy Street
Granville, IL 61326
Phone
(815) 339-2323
Fax
(815) 339-2324
NPI assigned
Nov 20, 2013
Last updated
Mar 16, 2022By the provider in NPPES
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
Troy Williams, RPH
Title
Owner/President
Phone
(309) 660-5939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

324 S. McCoy Street
Granville, IL 61326

Mailing address

PO Box 1087
Bloomington, IL 61702-1087
Phone (309) 828-6979

Other identifiers 1

IdentifierTypeStateIssuer
1488495OtherILNCPDP

Other names 1

  • Axline Pharmacy Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2181703Axline Pharmacy (07)324 S McCoy, Granville, IL 61326Certificate of waiverApr 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Axline Advanced7 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.

NPI Registry JSON

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

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1407286941",
    "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": "309-828-6979",
            "fax_number": "309-828-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 S. MCCOY STREET",
            "city": "GRANVILLE",
            "state": "IL",
            "postal_code": "61326",
            "telephone_number": "815-339-2323",
            "fax_number": "815-339-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXLINE'S INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "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": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "309-660-5939",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1488495",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Axline Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Axline Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Granville, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.