14D2181635 CLIA NUMBER - AXLINE PHARMACY (05)

Laboratory Demographics

  • CLIA Code: 14D2181635
  • Facility Name: AXLINE PHARMACY (05)
  • Facility Address: 1210 TOWANDA AVE - STE 11
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 309 828-6767
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TROY L. WILLIAMS
  • NPI Number: 1881355329
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2181635
LAB Type Pharmacy
Facility Name AXLINE PHARMACY (05)
Street 1210 TOWANDA AVE - STE 11
City BLOOMINGTON
State IL
ZIP 61701
Phone 309 828-6767
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2024
Certificate Expiration Date 4/7/2026
Facility Type Pharmacy
Lab Director TROY L. WILLIAMS

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This page was last updated on: 9/29/2025