Provider Demographics
NPI:1962636084
Name:AXIS LLC
Entity Type:Organization
Organization Name:AXIS LLC
Other - Org Name:AXIS GRP, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-872-7230
Mailing Address - Street 1:223 AIRTEX DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-6627
Mailing Address - Country:US
Mailing Address - Phone:281-872-7230
Mailing Address - Fax:281-251-5635
Practice Address - Street 1:223 AIRTEX DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-6627
Practice Address - Country:US
Practice Address - Phone:281-872-7230
Practice Address - Fax:281-251-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX266533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4554538OtherNCPDP PROVIDER IDENTIFICATION NUMBER