| Name: | SWC Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 01 Apr 2011 (14 years ago) (Companies founded in April 2011) |
| Date of dissolution: | 13 Apr 2016 |
| Entity Number: | 000-008-212 |
| Register Number: | 000008212 |
| ZIP code: | 35211 (Companies in Jefferson, 35211) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 832 PRNCETON AVENUE SWBIRMINGHAM, AL 35211 |
Activities
RETAIL PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356621650 | 2011-08-18 | 2013-03-06 | PO BOX 710, TRUSSVILLE, AL, 351730710, US | 832 PRINCETON AVE SW, BIRMINGHAM, AL, 352111320, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-941-9945 |
| Fax | 2056555102 |
| Phone | +1 205-397-4900 |
| Fax | 2052068464 |
Authorized person
| Name | KENNETH MINOR |
| Role | VP OF PHARMACY OPERATIONS |
| Phone | 2052130600 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113794 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 0137287 |
| Issuer | MEDICAID |
| Number | 133298 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SIMON-WILLIAMSON CLINIC P.C. | Agent | 832 PRINCETON AVENUE SWBIRMINGHAM, AL 35211 |
| Name | Role | Address |
|---|---|---|
| SIMON-WILLIAMSON CLINIC P.C. | Organizer | 832 PRINCETON AVENUE SWBIRMINGHAM, AL 35211 |
| HORTON, WILLIAM W | Organizer | JONES WALKER LLP, 420 20TH STREET NOBIRMINGHAM, AL 35203-5840 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
