| Name: | Foodland Pharmacy SB, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 Oct 2013 (11 years ago) (Companies founded in October 2013) |
| Entity Number: | 000-290-163 |
| Register Number: | 000290163 |
| ZIP code: | 35986 (Companies in De Kalb, 35986) |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Registered Office Street Address: | 246 MAIN STREET EASTRAINSVILLE, AL 35986 |
Activities
RETAIL/WHOLESALE SALE OF PHARMACY PRODUCTS
DRUGS
INFUSIONS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235567355 | 2013-10-29 | 2024-07-08 | 1402 COUNTY PARK RD STE 1, SCOTTSBORO, AL, 357693968, US | 1402 COUNTY PARK RD STE 1, SCOTTSBORO, AL, 357693968, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-259-1011 |
| Fax | 2562591138 |
Authorized person
| Name | DR. DAVID JOHN KINSLEY |
| Role | PHARMACY MANAGER/OWNER |
| Phone | 2562591011 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114233 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2142791 |
| Issuer | MEDICAID |
| Number | 154030 |
| State | AL |
| Name | Role |
|---|---|
| WILLMON, BENJI R | Agent |
| Name | Role | Address |
|---|---|---|
| KINSLEY, DAVID JOHN | Member | 1627 BURK DRIVE NWFORT PAYNE, AL 35967 |
| Name | Role | Address |
|---|---|---|
| BOSWELL, BRANDON | Organizer | 166 BOBO HOLLOW DRIVERAINSVILLE, AL 35986 |
| WILLIAMS, RODNEY HUGH | Organizer | 1199 CLEMENTS ROADRAINSVILLE, AL 35986 |
| WILLMON, BENJI RUSSELL | Organizer | 246 MAIN STREET EASTRAINSVILLE, AL 35986 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
