Name: | Medical Park Pharmacy, Inc. |
Jurisdiction: | Alabama |
Legal type: | Domestic Corporation |
Status: | Dissolved |
Date of registration: | 24 Jul 1978 (46 years ago) |
Date of dissolution: | 17 Jul 2020 |
Entity Number: | 000-052-305 |
Register Number: | 000052305 |
County: | Russell |
Place of Formation: | Russell County |
Principal Address: | PHENIX CITY, AL |
Registered Office Street Address: | 1623 21ST COURTPHENIX CITY, AL 36867 |
Registered Office Street Address ZIP Code: | 36867 |
Authorized Capital: | $10,000 |
Paid Share Capital: | $1,000 |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1629160841 | 2006-09-28 | 2020-08-22 | 1623 21ST CT, PHENIX CITY, AL, 36867, US | 1623 21ST CT, PHENIX CITY, AL, 36867, US | |||||||||||||||||||||||||||||
|
Phone | +1 334-298-4010 |
Fax | 3342980342 |
Authorized person
Name | MR. NORMAN WILLARD DAVIS |
Role | PRES |
Phone | 3342984010 |
Taxonomy
Taxonomy Code | 333600000X - Pharmacy |
License Number | 106743 |
State | AL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 00176063A |
State | GA |
Issuer | NABP |
Number | 0114289 |
Name | Role | Address |
---|---|---|
DAVIS, NORMAN W | Agent | 5008 2ND AVENUEPHENIX CITY, AL 36867 |
Name | Role | Address |
---|---|---|
BRYAN, LAWRENCE L | Incorporator | No data |
DAVIS, NORMAN W | Incorporator | 5008 2ND AVENUEPHENIX CITY, AL 36867 |
BRYAN, EMMA FRANCES | Incorporator | No data |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State