| Name: | MK Infusion Pharmacy LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 24 Jun 2015 (9 years ago) (Companies founded in June 2015) |
| Entity Number: | 000-338-839 |
| Register Number: | 000338839 |
| ZIP code: | 35661 (Companies in Colbert, 35661) |
| County: | Colbert |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 307 W STATE STMUSCLE SHOALS, AL 35661 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093179509 | 2016-04-11 | 2020-12-15 | 307 W STATE ST, MUSCLE SHOALS, AL, 356612835, US | 307 W STATE ST, MUSCLE SHOALS, AL, 356612835, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-320-7611 |
| Fax | 2563207607 |
Authorized person
| Name | MISSY MONTGOMERY |
| Role | CLINICAL PHARMACIST / CEO |
| Phone | 2563207611 |
Taxonomy
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| License Number | 14795/7.1 |
| State | MS |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 0000005791 |
| State | TN |
| Is Primary | No |
| Taxonomy Code | 3336H0001X - Home Infusion Therapy Pharmacy |
| License Number | 114617 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 187872 |
| State | AL |
| Issuer | PK |
| Number | 2159515 |
| Name | Role | Address |
|---|---|---|
| MONTGOMERY, MARC W | Agent | 307 WEST STATE STREETMUSCLE SHOALS, AL 35661 |
| Name | Role | Address |
|---|---|---|
| LEGALZOOM.COM INC | Organizer | 101 N BRAND BLVD 10TH FLOORGLENDALE, CA 91203 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
