| Name: | Southeast Pharmaceuticals, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 17 Jan 1995 (30 years ago) |
| Entity Number: | 000-169-541 |
| Register Number: | 000169541 |
| County: | Coffee |
| Place of Formation: | Coffee County |
| Principal Address: | ELBA, AL |
| Registered Office Street Address: | 704-A TROY HWYELBA, AL 36323 |
| Registered Office Street Address ZIP Code: | 36323 |
| Authorized Capital: | $100 |
| Paid Share Capital: | $100 |
Activities
COMPLETE PHARMACEUTICAL RELATED CARE SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518054816 | 2006-10-06 | 2011-11-30 | PO BOX 415, ELBA, AL, 363230415, US | 704 TROY HWY, STE A, ELBA, AL, 363231521, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-897-3746 |
| Fax | 3348973716 |
Authorized person
| Name | MR. JOHN NEAL HOLLEY |
| Role | PRESIDENT |
| Phone | 3348973746 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 027146 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 332BC3200X - Customized Equipment (DME) |
| License Number | 027146 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| License Number | 027146 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| License Number | 027146 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106273501 |
| State | FL |
| Issuer | MEDICAID |
| Number | 009505350 |
| State | AL |
| Issuer | BCBS |
| Number | 510-36152 |
| State | AL |
| Name | Role |
|---|---|
| HOLLEY, JOHN NEAL | Incorporator |
| HOLLEY, MARY HARMON | Incorporator |
| HOLLEY, JIMMY WALLACE | Incorporator |
| Name | Role | Address |
|---|---|---|
| HOLLEY, JOHN N | Agent | 404 SPRINGDALE DRIVEENTERPRISE, AL 36330 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
