| Name: | Family Medicine Pharmacy, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Dec 2010 (14 years ago) (Companies founded in December 2010) |
| Entity Number: | 000-304-757 |
| Register Number: | 000304757 |
| ZIP code: | 36784 (Companies in Clarke, 36784) |
| County: | Clarke |
| Place of Formation: | Clarke County |
| Principal Address: | THOMASVILLE, AL |
| Registered Office Street Address: | 470 SAFFORD AVETHOMASVILLE, AL 36784 |
Activities
RETAIL PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093829061 | 2006-08-18 | 2018-07-19 | 470 SAFFORD AVE W, THOMASVILLE, AL, 367843112, US | 470 SAFFORD AVE W, THOMASVILLE, AL, 367843112, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 334-636-9809 |
| Fax | 3346369807 |
Authorized person
| Name | GARY WISE |
| Role | OWNER |
| Phone | 3346369809 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 103869 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 1991227 |
| Issuer | MEDICAID |
| Number | 124922 |
| State | AL |
| Name | Role |
|---|---|
| WISE, GARY MARK | Agent |
| Name | Role |
|---|---|
| WISE, GARY MARK | Member |
| WISE, ANGELA PATE | Member |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
