| Name: | LAKESIDE PHARMACY OF ALABAMA, INC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 01 Mar 2012 (13 years ago) (Companies founded in March 2012) |
| Date of dissolution: | 28 Feb 2020 |
| Entity Number: | 000-043-501 |
| Register Number: | 000043501 |
| ZIP code: | 36278 (Companies in Randolph, 36278) |
| County: | Randolph |
| Place of Formation: | Randolph County |
| Principal Address: | 17054 HIGHWAY 431WEDOWEE, AL 36278 |
| Registered Office Street Address: | 17054 HIGHWAY 431WEDOWWE, AL 36278 |
| Principal Mailing Address: | PO BOX 10WEDOWEE, AL 36278 |
| Authorized Capital: | 1,000 @ $1 PV |
Activities
RETAIL PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518232941 | 2012-03-19 | 2012-04-20 | PO BOX 10, WEDOWEE, AL, 362780010, US | 17054 HIGHWAY 431, WEDOWEE, AL, 362784572, US | |||||||||||||||||||||||
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| Phone | +1 256-357-2315 |
| Fax | 2563572319 |
Authorized person
| Name | WILL JACKS |
| Role | OWNER/MANAGING PHARMACIST |
| Phone | 2563572315 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113866 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 0137679 |
| Name | Role |
|---|---|
| JACKS, WILL D II | Agent |
| Name | Role | Address |
|---|---|---|
| JACKS, WILL DAVID II | Director | 17054 HIGHWAY 431WEDOWWE, AL 36278 |
| Name | Role | Address |
|---|---|---|
| WARD, HEATHER E | Incorporator | 4TH FLOOR, 109 NORTH 20TH STREETBIRMINGHAM, AL 35202 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
