| Name: | Southside Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 24 Aug 2011 (13 years ago) |
| Entity Number: | 000-023-980 |
| Register Number: | 000023980 |
| County: | Limestone |
| Place of Formation: | Limestone County |
| Registered Office Street Address: | 11964 ESCUE DRIVE SUITE ATANNER, AL 35671 |
| Registered Office Street Address ZIP Code: | 35671 |
| Authorized Capital: | 5,000 @ $1 PV |
Activities
DISPENSE OF PHARMACEUTICAL SUPPLIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548544752 | 2011-10-06 | 2016-01-27 | 11964 ESCUE DR, SUITE A, TANNER, AL, 356713679, US | 11964 ESCUE DR STE A, TANNER, AL, 356713680, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-232-6588 |
| Fax | 2562326589 |
Authorized person
| Name | TAMMY GARRETT |
| Role | PHARMACIST/PRESIDENT |
| Phone | 2562326588 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113810 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2132353 |
| Issuer | MEDICAID |
| Number | 134219 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SOUTHSIDE PHARMACY, INC. 401(K) PROFIT SHARING PLAN | 2016 | 453033083 | 2017-07-26 | SOUTHSIDE PHARMACY, INC. | 10 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2017-07-26 |
| Name of individual signing | TAMMY GARRETT |
| Name | Role |
|---|---|
| GASRRETT, TAMMY | Agent |
| Name | Role | Address |
|---|---|---|
| GARRETT, TAMMY | Director | 11964 ESCUE DRIVE SUITE ATANNER, AL 35671 |
| Name | Role | Address |
|---|---|---|
| GARRETT, TAMMY | Incorporator | 11964 ESCUE DRIVE SUITE ATANNER, AL 35671 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
