Provider Demographics
NPI:1396174892
Name:ALIXA RX LLC
Entity type:Organization
Organization Name:ALIXA RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-372-6300
Mailing Address - Street 1:6400 PINECREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2962
Mailing Address - Country:US
Mailing Address - Phone:214-778-0300
Mailing Address - Fax:
Practice Address - Street 1:11225 DAVENPORT ST
Practice Address - Street 2:SUITE 104A
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2641
Practice Address - Country:US
Practice Address - Phone:479-201-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARINA PHARMACY CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-05
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE550333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026399500Medicaid