| Name: | Collinsville Express Drugs, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 10 Jan 2013 (12 years ago) (Companies founded in January 2013) |
| Entity Number: | 000-272-403 |
| Register Number: | 000272403 |
| ZIP code: | 35986 (Companies in De Kalb, 35986) |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Registered Office Street Address: | 166 BOBO HOLLOW DRIVERAINSVILLE, AL 35986 |
Activities
ENGAGE IN THE RETAIL AND WHOLESALE OF PHARMACY PRODUCTS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679811160 | 2013-01-18 | 2013-03-12 | PO BOX 4498, COLLINSVILLE, AL, 35961, US | 588 S VALLEY AVE, COLLINSVILLE, AL, 359613535, US | |||||||||||||||||||||||
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| Phone | +1 256-524-2981 |
| Fax | 2565242987 |
Authorized person
| Name | BRANDON BOSWELL |
| Role | OWNER/PIC |
| Phone | 2565242981 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 112980 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 0138467 |
| Name | Role | Address |
|---|---|---|
| BOSWELL, BRANDON | Agent | 166 BOBO HOLLOW DRIVERAINSVILLE, AL 35986 |
| Name | Role | Address |
|---|---|---|
| BOSWELL, BRANDON | Organizer | 166 BOBO HOLLOW DRIVERAINSVILLE, AL 35986 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
