Provider Demographics
NPI:1073740676
Name:MIRIXA CORPORATION
Entity Type:Organization
Organization Name:MIRIXA CORPORATION
Other - Org Name:COMMUNITY PHARMACY SERVICES ('CPS')
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP OPERATIONS AND GENERAL COUNSEL
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LITSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:703-865-2007
Mailing Address - Street 1:11600 SUNRISE VALLEY DR SUITE 100
Mailing Address - Street 2:MIRIXA CORPORATION/COMMUNITY PHARMACY SERVICES ('CPS')
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1412
Mailing Address - Country:US
Mailing Address - Phone:703-774-9607
Mailing Address - Fax:855-855-7440
Practice Address - Street 1:11600 SUNRISE VALLEY DR SUITE 100
Practice Address - Street 2:MIRIXA CORPORATION/COMMUNITY PHARMACY SERVICES ('CPS')
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1412
Practice Address - Country:US
Practice Address - Phone:703-774-9607
Practice Address - Fax:855-855-7440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRIXA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-22
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty