| Name: | HOMETOWN PHARMACY OF LIMESTONE COUNTY, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 07 Nov 2013 (11 years ago) (Companies founded in November 2013) |
| Entity Number: | 000-291-051 |
| Register Number: | 000291051 |
| ZIP code: | 35613 (Companies in Limestone, 35613) |
| County: | Limestone |
| Place of Formation: | Limestone County |
| Registered Office Street Address: | 22335 HIGHWAY 72 EAST SUITE DATHENS, AL 35613 |
Activities
OWN AND OPERATE A PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497176564 | 2013-12-17 | 2021-10-05 | 1406 LINDSAY LN S STE A, ATHENS, AL, 356132710, US | 100 HIGHWAY 31, SUITE H, ATHENS, AL, 35611, US | |||||||||||||||||||||||||||||
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| Phone | +1 256-233-7070 |
| Fax | 2562338891 |
| Phone | +1 256-232-8448 |
| Fax | 2562321302 |
Authorized person
| Name | MONIQUE CANNON |
| Role | OWNER/AO/PHARMACIST |
| Phone | 2562337070 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114259 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 157184 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CANNON, BILLY R JR | Agent | 22335 HIGHWAY 72 EAST SUITE DATHENS, AL 35613 |
| Name | Role | Address |
|---|---|---|
| CANNON, BILLY R JR | Organizer | 22335 HIGHWAY 72 EAST SUITE DATHENS, AL 35613 |
| JONES, D ASHLEY | Organizer | 100 WASHINGTON STREET STE 100HUNTSVILLE, AL 35801 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
