Provider Demographics
NPI:1154784403
Name:PHARMIX RX LLC
Entity type:Organization
Organization Name:PHARMIX RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-478-3522
Mailing Address - Street 1:66 VILLAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-1221
Mailing Address - Country:US
Mailing Address - Phone:334-478-3522
Mailing Address - Fax:334-478-3518
Practice Address - Street 1:66 VILLAGE LOOP
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-1221
Practice Address - Country:US
Practice Address - Phone:334-478-3522
Practice Address - Fax:334-478-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159418OtherPK