| Name: | Holley Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 25 Nov 2015 (9 years ago) |
| Entity Number: | 000-349-563 |
| Register Number: | 000349563 |
| County: | Coffee |
| Place of Formation: | Coffee County |
| Principal Address: | 612 N MAIN STREET SUITE AENTERPRISE, AL 36330 |
| Principal Address ZIP Code: | 36330 |
| Principal Mailing Address: | PO BOX 415ELBA, AL 36323 |
| Principal Mailing Address ZIP Code: | 36323 |
| Authorized Capital: | 100 @ $1 PV |
Activities
OWN/OPERATE PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568822021 | 2016-02-26 | 2018-07-19 | 612 N MAIN ST STE A, ENTERPRISE, AL, 363301775, US | 612 N MAIN ST STE A, ENTERPRISE, AL, 363301775, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-393-0086 |
| Fax | 3343930206 |
Authorized person
| Name | JOHN HOLLEY |
| Role | OWNER/PRESIDENT/PIC/AO |
| Phone | 3343930086 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114591 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 183049 |
| State | AL |
| Issuer | PK |
| Number | 2158301 |
| Name | Role | Address |
|---|---|---|
| HOLLEY, JASON | Director | 3008 COUNTY ROAD 364ELBA, AL 36323 |
| HOLLEY, JOHN | Director | 612 N MAIN STREET SUITE AENTERPRISE, AL 36330 |
| Name | Role | Address |
|---|---|---|
| HOLLEY, JOHN | Incorporator | 612 N MAIN STREET SUITE AENTERPRISE, AL 36330 |
| HOLLEY, JASON | Incorporator | 3008 COUNTY ROAD 364ELBA, AL 36323 |
| Name | Role | Address |
|---|---|---|
| HOLLEY, JOHN | Agent | 612 N MAIN STREET SUITE AENTERPRISE, AL 36330 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
