| Name: | Heavenly Care Pharmacy L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Dec 2012 (12 years ago) (Companies founded in December 2012) |
| Entity Number: | 000-271-546 |
| Register Number: | 000271546 |
| ZIP code: | 35020 (Companies in Jefferson, 35020) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | 100 GRIFFIN AVEBESSEMER, AL 35020 |
Activities
PHARMACEUTICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417372046 | 2014-02-18 | 2017-02-15 | PO BOX 1686, BESSEMER, AL, 350211686, US | 617 9TH AVE N, BESSEMER, AL, 350205368, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 205-434-1427 |
| Fax | 2055658329 |
Authorized person
| Name | SANTONIA DAVISON |
| Role | OWNER |
| Phone | 2054341427 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114300 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 158195 |
| State | AL |
| Issuer | PK |
| Number | 2144363 |
| Name | Role | Address |
|---|---|---|
| STANFORD, SANTONIA | Organizer | 100 GRIFFIN AVEBESSEMER, AL 35020 |
| STANFORD, SANTONIA SHERIA | Organizer | 100 GRIFFIN AVEBESSEMER, AL 35020 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
