NPIMap

Organization Active NPI

Alixa RX LLC

Doing business as Alixa RX

  • Long Term Care Pharmacy
  • Eden Prairie, MN
National Provider Identifier
1497020390
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
ALIXA RX LLC
Doing business as
Alixa RX
Practice address
10132 West 76TH St
Eden Prairie, MN 55344
Phone
(972) 372-6334
NPI assigned
Mar 12, 2012
Last updated
Nov 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MARINA PHARMACY CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael ShamalovNPI 1114162799
Title
Managing Member
Phone
(631) 321-3850

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

10132 West 76TH St
Eden Prairie, MN 55344

Mailing address

10132 West 76TH St
Eden Prairie, MN 55344

Other names 1

  • Alixa RX Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI, IA6 enrollments

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
O20210304000803 MN Part B Supplier - Mass Immunization (Roster Biller Only) 0345474102 Practice locations: Saint Charles, MN; Rochester, MN; Red Wing, MN; La Crescent, MN; Hopkins, MN; Eden Prairie, MN; Duluth, MN; Crookston, MN…
O20210304001076 WI Part B Supplier - Pharmacy 0345474102 Practice locations: Weston, WI; Watertown, WI; Tomahawk, WI; Rib Lake, WI; Oak Creek, WI; Muscoda, WI; Milwaukee, WI; Hayward, WI…
O20210304001753 WI Part B Supplier - Mass Immunization (Roster Biller Only) 0345474102 Practice locations: Glendale, WI; Hayward, WI; Milwaukee, WI; Oak Creek, WI
O20210304001973 MN Part B Supplier - Pharmacy 0345474102 Practice locations: Hopkins, MN; Saint Charles, MN; Rochester, MN; Red Wing, MN; La Crescent, MN; Elk River, MN; Eden Prairie, MN; Duluth, MN…
O20210423000174 IA Part B Supplier - Pharmacy 0345474102 Practice locations: Bettendorf, IA; Mount Pleasant, IA; Wellman, IA
O20240412003568 MN DME Supplier - Pharmacy 0345474102 Practice locations: Eden Prairie, MN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Alixa RX - Minnesota10132 W 76TH St, Eden Prairie, MN 55344-3728(612) 486-1900 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Dec 1, 2020

National Provider Directory

National Provider Directory
Tax ID family
Alixa RX LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10132 W 76th St
Eden Prairie, MN 55344
Phone (877) 323-4292

6400 Pinecrest Dr
Ste 200
Plano, TX 75024
Phone (954) 977-6977

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1497020390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10132 WEST 76TH ST",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "55344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10132 WEST 76TH ST",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "55344",
            "telephone_number": "972-372-6334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALIXA RX LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARINA PHARMACY CORP",
        "enumeration_date": "2012-03-12",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "SHAMALOV",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "631-321-3850"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alixa RX",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alixa RX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.