| Name: | Avalon Pharmacy Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 30 Oct 1996 (28 years ago) |
| Entity Number: | 000-183-249 |
| Register Number: | 000183249 |
| County: | Colbert |
| Place of Formation: | Colbert County |
| Principal Address: | MUSCLE SHOALS, AL |
| Registered Office Street Address: | 2400 AVALON AVEMUSCLE SHOALS, AL 35661 |
| Registered Office Street Address ZIP Code: | 35661 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PHARMACY BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871620526 | 2007-02-28 | 2008-03-11 | 2400 AVALON AVE, MUSCLE SHOALS, AL, 356613164, US | 2400 AVALON AVE, MUSCLE SHOALS, AL, 356613164, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-314-1001 |
| Fax | 2563141002 |
Authorized person
| Name | MR. JAMES MARK RAY |
| Role | RPH |
| Phone | 2563141001 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 110779 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 110779 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| License Number | 110779 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009703940 |
| State | AL |
| Issuer | MEDICAID |
| Number | 100002842 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| RAY, JAMES MARK | Agent | 107 PINEWOOD DRIVEMUSCLE SHOALS, AL 35661 |
| Name | Role |
|---|---|
| RAY, CLYDE JR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
