| Name: | Jackson's Rocky Ridge Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 22 Mar 1999 (26 years ago) |
| Entity Number: | 000-201-767 |
| Register Number: | 000201767 |
| County: | Jefferson |
| Place of Formation: | Tallapoosa County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 241 RALIEGH AVEBIRMINGHAM, AL 35209 |
| Registered Office Street Address ZIP Code: | 35209 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PHARMACY & GIFT SHOP
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881927192 | 2009-09-18 | 2023-03-07 | 2108 GATEWAY DR, SUITE F, OPELIKA, AL, 368016886, US | 3346 MORGAN DR, BIRMINGHAM, AL, 352163052, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 205-822-5200 |
| Fax | 2059793666 |
Authorized person
| Name | DR. BRAD F JACKSON |
| Role | PRESIDENT |
| Phone | 2058225200 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | PENDING NPI APPROVAL |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF ALABAMA |
| Number | 515-40811 |
| State | AL |
| Issuer | NCPDP |
| Number | 0102018 |
| State | AL |
| Issuer | MEDICAID |
| Number | 100003250 |
| State | AL |
| Name | Role |
|---|---|
| JACKSON, BRADLEY F | Agent |
| Name | Role |
|---|---|
| JACKSON, BRADLEY F | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
