| Name: | DOUBLE OAK MOUNTAIN PHARMACY LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 Nov 2011 (13 years ago) |
| Entity Number: | 000-024-605 |
| Register Number: | 000024605 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Registered Office Street Address: | 1024 EAGLE LAKE CIRCLEBIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| Principal Address: | 5510 HIGHWAY 280 SOUTH SUITE 123BIRMINGHAM, AL 35242 |
| Principal Address ZIP Code: | 35242 |
Activities
RETAIL PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154693737 | 2012-01-30 | 2016-02-18 | 5510 HIGHWAY 280 STE 123, BIRMINGHAM, AL, 352426582, US | 5510 HIGHWAY 280 STE 123, BIRMINGHAM, AL, 352426582, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-991-0800 |
| Fax | 2059910810 |
Authorized person
| Name | JOSEPH FEICK |
| Role | OWNER/TCH/AO |
| Phone | 2059910800 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113854 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2133626 |
| Issuer | MEDICAID |
| Number | 135221 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| FEICK, JOSEPH U JR | Organizer | 904 MOUNTAIN BRANCH DRVESTAVIA, AL 35226 |
| FEICK, JOSEPH U SR | Organizer | 1024 EAGLE LAKE CIRCLEBIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| FEICK, JOSEPH U SR | Agent | 1024 EAGLE LAKE CIRCLEBIRMINGHAM, AL 35242 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
