Healthcare Provider Details

I. General information

NPI: 1033530977
Provider Name (Legal Business Name): ALIXA RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 W SHAW AVE
FRESNO CA
93722-6209
US

IV. Provider business mailing address

7160 DALLAS PKWY SUITE 400
PLANO TX
75024-7145
US

V. Phone/Fax

Practice location:
  • Phone: 559-277-4100
  • Fax:
Mailing address:
  • Phone: 972-372-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHAMALOV
Title or Position: MANAGING MEMBER
Credential:
Phone: 631-321-3850