| 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 | |||||||||||||||||||||||||||||
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| 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
