Provider Demographics
NPI:1891492120
Name:AXLINE PHARMACY II INC.
Entity Type:Organization
Organization Name:AXLINE PHARMACY II INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMD
Authorized Official - Prefix:MRS
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-435-0958
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-1087
Mailing Address - Country:US
Mailing Address - Phone:309-828-6767
Mailing Address - Fax:309-828-6970
Practice Address - Street 1:415 5TH ST
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540-1211
Practice Address - Country:US
Practice Address - Phone:309-554-4023
Practice Address - Fax:309-554-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy