| Name: | Gentry Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 27 Jan 2011 (14 years ago) |
| Entity Number: | 000-001-467 |
| Register Number: | 000001467 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 2662 DENYSE DRIVEBIRMINGHAM, AL 35243 |
| Registered Office Street Address ZIP Code: | 35243 |
Activities
RETAIL PHARMACY BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578857108 | 2011-05-31 | 2021-08-19 | 3100 BLUE LAKE DRIVE, VESTAVIA, AL, 35243, US | 3100 BLUE LAKE DRIVE, VESTAVIA, AL, 35243, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-970-1983 |
| Fax | 2059701986 |
Authorized person
| Name | ROBERT CLINT GENTRY |
| Role | OWNER/MANAGER |
| Phone | 2059701983 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113729 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2130074 |
| Issuer | MEDICAID |
| Number | 129374 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| PRITCHARD, WILLIAM S III | Organizer | 505 20TH STREET N STE 1210BIRMINGHAM, AL 35203 |
| GENTRY, ROBERT CLINTON | Organizer | 2662 DENYSE DRIVEBIRMINGHAM, AL 35243 |
| Name | Role |
|---|---|
| GENTRY, ROBERT C | Agent |
Date of last update: 29 Jul 2024
Sources: Alabama Secretary of State
