Provider Demographics
NPI:1003152497
Name:ALIXA RX LLC
Entity type:Organization
Organization Name:ALIXA RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-372-6429
Mailing Address - Street 1:3100 NORTHWOODS PL
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1670
Mailing Address - Country:US
Mailing Address - Phone:855-428-3564
Mailing Address - Fax:
Practice Address - Street 1:3100 NORTHWOODS PL
Practice Address - Street 2:SUITE F
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1670
Practice Address - Country:US
Practice Address - Phone:855-428-3564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARINA PHARMACY CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-13
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy