| Name: | Mill Street Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 10 Dec 2014 (10 years ago) |
| Entity Number: | 000-324-090 |
| Register Number: | 000324090 |
| County: | Marshall |
| Place of Formation: | Marshall County |
| Registered Office Street Address: | 10639 AL HWY 168BOAZ, AL 35957 |
| Registered Office Street Address ZIP Code: | 35957 |
| Authorized Capital: | 1000 @ $1.00PV |
Activities
RETAIL PHARMACY BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295837300 | 2006-09-01 | 2017-02-22 | 10639 AL HIGHWAY 168, BOAZ, AL, 359571955, US | 10639 AL HIGHWAY 168, BOAZ, AL, 359571955, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-593-5279 |
| Fax | 2565931991 |
Authorized person
| Name | PATRICK PHILLIPS |
| Role | OWNER |
| Phone | 2565935279 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 111177 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 169336 |
| State | AL |
| Issuer | PK |
| Number | 2150239 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MILL STREET PHARMACY 401(K) PROFIT SHARING PLAN AND TRUST | 2014 | 631245618 | 2015-06-08 | MILL STREET PHARMACY | 9 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2015-06-08 |
| Name of individual signing | JEFFREY C. ROBERTS |
| File | View Page |
| Three-digit plan number (PN) | 002 |
| Effective date of plan | 2012-01-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 2565935279 |
| Plan sponsor’s address | 10693 AL HWY 168, BOAZ, AL, 35957 |
Signature of
| Role | Plan administrator |
| Date | 2014-05-21 |
| Name of individual signing | JEFFREY C. ROBERTS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-01-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 2565935279 |
| Plan sponsor’s address | 10693 AL HWY 168, BOAZ, AL, 35957 |
Signature of
| Role | Plan administrator |
| Date | 2013-07-25 |
| Name of individual signing | JEFFREY C. ROBERTS |
| Name | Role | Address |
|---|---|---|
| PHILLIPS, PATRICK J | Agent | 119 COLLEGE AVENUEBOAZ, AL 35957 |
| Name | Role | Address |
|---|---|---|
| PHILLIPS, PATRICK J | Director | 119 COLLEGE AVENUEBOAZ, AL 35957 |
| Name | Role | Address |
|---|---|---|
| PHILLIPS, PATRICK J | Incorporator | 119 COLLEGE AVENUEBOAZ, AL 35957 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
