Provider Demographics
NPI:1518384940
Name:ALEX PHARM LLC
Entity Type:Organization
Organization Name:ALEX PHARM LLC
Other - Org Name:PALISADES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & PIC
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MISAK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:202-362-0004
Mailing Address - Street 1:5185 MACARTHUR BLVD NW # 107
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3341
Mailing Address - Country:US
Mailing Address - Phone:202-362-0004
Mailing Address - Fax:202-362-0006
Practice Address - Street 1:5185 MACARTHUR BLVD NW # 107
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3341
Practice Address - Country:US
Practice Address - Phone:202-362-0004
Practice Address - Fax:202-362-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
DCRX00000683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC097080400Medicaid
2147432OtherPK