| Name: | CORNER CROSSING, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 Apr 2014 (11 years ago) |
| Entity Number: | 000-307-998 |
| Register Number: | 000307998 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | 3002 FIRETHORN DRIVEHAMPTON COVE, AL 35763 |
| Principal Address ZIP Code: | 35763 |
| Registered Office Street Address: | 30694 U.S. HIGHWAY 72 WEST, NW STE AMADISON, AL 35756 |
| Registered Office Street Address ZIP Code: | 35756 |
Activities
OPERATE A PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609271220 | 2014-10-24 | 2018-01-19 | 30694 HIGHWAY 72 WEST, SUITE A, HUNTSVILLE, AL, 35756, US | 30694 HIGHWAY 72 WEST, SUITE A, HUNTSVILLE, AL, 35756, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-230-6200 |
| Fax | 2562306232 |
Authorized person
| Name | JT LEATHERWOOD |
| Role | OWNER, PIC, AO |
| Phone | 2562306200 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114500 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 176134 |
| State | AL |
| Issuer | PK |
| Number | 2150075 |
| Name | Role |
|---|---|
| LEATHERWOOD, JERRERD T | Agent |
| Name | Role | Address |
|---|---|---|
| NUWAYHID, NADIM A | Organizer | 3002 FIRETHORN DRIVEHAMPTON COVE, AL 35763 |
| NUWAYHID, MAZEN R | Organizer | 3006 TWELVE STONESHAMPTON COVE, AL 35763 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
