0001493152-21-032038.txt : 20211220 0001493152-21-032038.hdr.sgml : 20211220 20211220161540 ACCESSION NUMBER: 0001493152-21-032038 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211220 FILED AS OF DATE: 20211220 DATE AS OF CHANGE: 20211220 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rachman Ilya M CENTRAL INDEX KEY: 0001889334 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41159 FILM NUMBER: 211505435 MAIL ADDRESS: STREET 1: 11400 WEST OLYMPIC BLVD., STREET 2: SUITE 200 CITY: LOS ANGELES STATE: CA ZIP: 90064 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Immix Biopharma, Inc. CENTRAL INDEX KEY: 0001873835 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 454869378 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 11400 WEST OLYMPIC BLVD. STREET 2: SUITE 200 CITY: LOS ANGELES STATE: CA ZIP: 90064 BUSINESS PHONE: (888) 958-1084 MAIL ADDRESS: STREET 1: 10573 W. PICO BLVD. STREET 2: #58 CITY: LOS ANGELES STATE: CA ZIP: 90064 4 1 ownership.xml X0306 4 2021-12-20 0 0001873835 Immix Biopharma, Inc. IMMX 0001889334 Rachman Ilya M C/O IMMIX BIOPHARMA, INC. 11400 WEST OLYMPIC BLVD., SUITE 200 LOS ANGELES CA 90064 1 1 0 0 CEO and Chairman Common Stock 2021-12-20 4 P 0 2500 5.00 A 902500 D /s/ Ilya Rachman 2021-12-20