| Name: | Colburn's Northport Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 11 Apr 1990 (35 years ago) |
| Entity Number: | 000-136-578 |
| Register Number: | 000136578 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | NORTHPORT, AL |
| Registered Office Street Address: | 909 MCFARLAND BOULEVARD NORTHNORTHPORT, AL 35476 |
| Registered Office Street Address ZIP Code: | 35476 |
| Authorized Capital: | $5,000 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306944269 | 2006-09-21 | 2010-03-01 | 909 MCFARLAND BLVD, NORTHPORT, AL, 354763373, US | 909 MCFARLAND BLVD, NORTHPORT, AL, 354763373, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 205-339-5800 |
| Fax | 2053395851 |
Authorized person
| Name | ROBERT M COLBURN JR. |
| Role | OWNER |
| Phone | 2053395800 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 102610 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 102610 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP |
| Number | 0102309 |
| Issuer | MEDICAID |
| Number | 100000181 |
| State | AL |
| Name | Role |
|---|---|
| COLBURN, ROBERT M JR | Agent |
| Name | Role |
|---|---|
| COLBURN, ROBERT M JR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
