Provider Demographics
NPI:1770854861
Name:ALIXA RX LLC
Entity Type:Organization
Organization Name:ALIXA RX LLC
Other - Org Name:ALIXARX - PA HUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMALOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-321-3850
Mailing Address - Street 1:6400 PINECREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2959
Mailing Address - Country:US
Mailing Address - Phone:972-372-6337
Mailing Address - Fax:
Practice Address - Street 1:1041 WASHINGTON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2704
Practice Address - Country:US
Practice Address - Phone:412-319-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARINA PHARMACY CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6858520001Medicare UPIN