Provider Demographics
NPI:1255721411
Name:AXION INC
Entity type:Organization
Organization Name:AXION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-891-2335
Mailing Address - Street 1:8139 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3626
Mailing Address - Country:US
Mailing Address - Phone:313-891-2335
Mailing Address - Fax:
Practice Address - Street 1:8139 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3626
Practice Address - Country:US
Practice Address - Phone:313-891-2335
Practice Address - Fax:313-891-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010106063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255721411Medicaid
2149834OtherPK