| Name: | Family Pharmacy of Littleville, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 09 Apr 2010 (15 years ago) |
| Entity Number: | 000-263-896 |
| Register Number: | 000263896 |
| County: | Colbert |
| Place of Formation: | Franklin County |
| Principal Address: | MUSCLE SHOALS, AL |
| Registered Office Street Address: | 118 STORMY DRMUSCLE SHOALS, AL 35661 |
| Registered Office Street Address ZIP Code: | 35661 |
| Authorized Capital: | $100 |
| Paid Share Capital: | $100 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952625964 | 2010-03-19 | 2017-04-14 | 1369B GEORGE WALLACE HWY, RUSSELLVILLE, AL, 356543281, US | 1369B GEORGE WALLACE HWY, RUSSELLVILLE, AL, 356543281, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 256-332-4021 |
| Fax | 2563324026 |
Authorized person
| Name | JEREMY LANE |
| Role | OWNER |
| Phone | 2563324021 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113363 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2124673 |
| Issuer | MEDICAID |
| Number | 118534 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| KIEL, JODY | Incorporator | 118 STORMY DRIVEMUSCLE SHOALS, AL 35661 |
| LANE, JEREMY | Incorporator | 311 WEST ROOSEVELT AVENUEMUSCLE SHOALS, AL 35661 |
| DEARMAN, CARRIE | Incorporator | No data |
| Name | Role | Address |
|---|---|---|
| KIEL, JODY | Agent | 118 STORMY DRIVEMUSCLE SHOALS, AL 35661 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
