| Name: | Pell City Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 12 May 2009 (16 years ago) |
| Entity Number: | 000-260-910 |
| Register Number: | 000260910 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Registered Office Street Address: | 110 SOUTHLEDGEBIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| Authorized Capital: | $10 |
Activities
PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073748877 | 2009-05-21 | 2017-02-20 | 1027 MARTIN ST S, PELL CITY, AL, 351282360, US | 1027 MARTIN ST S, PELL CITY, AL, 351282360, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 205-338-6080 |
| Fax | 2053386082 |
Authorized person
| Name | TUCKER MALONE |
| Role | PHARMACIST/OWNER |
| Phone | 3344440376 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113272 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1073748877 |
| State | AL |
| Issuer | PK |
| Number | 2120548 |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7JPR1 | Obsolete | Non-Manufacturer | 2016-01-26 | 2022-01-22 | 2022-01-21 | No data | |||||||||||||
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| POC | TUCKER MALONE |
| Phone | +1 205-338-6080 |
| Address | 1027 MARTIN ST S, PELL CITY, AL, 35128 2360, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role | Address |
|---|---|---|
| MALONE, TUCKER | Agent | 1021 CROSSROADS PLAZA DRIVEMOODY, AL 35004 |
| Name | Role | Address |
|---|---|---|
| MALONE, TUCKER | Director | 1021 CROSSROADS PLAZA DRIVEMOODY, AL 35004 |
| Name | Role |
|---|---|
| BROCK, RANDY | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
