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Carrollton Prescription Shop, Inc.

Details

Name: Carrollton Prescription Shop, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 10 Jan 1986 (39 years ago)
Entity Number: 000-108-093
Register Number: 000108093
County: Winston
Place of Formation: Pickens County
Registered Office Street Address: 4037 US 231 STE AWETUMPKA, AL 36093
Registered Office Street Address ZIP Code: 36093
Principal Address: 41254 HIGHWAY 195 SUITE GHALEYVILLE, AL 35565
Principal Address ZIP Code: 35565
Authorized Capital: $1,000
Paid Share Capital: $1,000

Activities PHARMACY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1003821612 2006-07-30 2015-12-10 41254 HIGHWAY 195, SUITE G, HALEYVILLE, AL, 355658114, US 41254 HIGHWAY 195 STE G, HALEYVILLE, AL, 355658115, US

Contacts

Phone +1 205-494-7150
Fax 2054851133
Fax 2054851130

Authorized person

Name JEFF SOUTH
Role MANAGER
Phone 2054947150

Taxonomy

Taxonomy Code 333600000X - Pharmacy
License Number 109667
State AL
Is Primary Yes
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
Is Primary No

Other Provider Identifiers

Issuer PK
Number 2152742
Issuer MEDICAID
Number 100001842
State AL

Agent

Name Role Address
INCORP SERVICES INC Agent 3773 HOWARD HUGHES PKWY SUITE 500SLAS VEGAS, NV 89169

Incorporator

Name Role
JOHNSTON, R R JR Incorporator

Date of last update: 31 Jul 2024

Sources: Alabama Secretary of State