| 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
| 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 | |||||||||||||||||||||||||||||||||||
|
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| 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 |
| Name | Role | Address |
|---|---|---|
| INCORP SERVICES INC | Agent | 3773 HOWARD HUGHES PKWY SUITE 500SLAS VEGAS, NV 89169 |
| Name | Role |
|---|---|
| JOHNSTON, R R JR | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
