| Name: | LEGACY COMPOUNDING, INC. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 08 Dec 2015 (9 years ago) |
| Entity Number: | 000-350-726 |
| Register Number: | 000350726 |
| Historical Names: |
PILLBOX EXPRESS, INC.
|
| County: | Morgan |
| Place of Formation: | Morgan County |
| Principal Address: | 2422 DANVILLE RD SW SUITE HDECATUR, AL 35603 |
| Principal Address ZIP Code: | 35603 |
| Authorized Capital: | 1,000 |
Activities
PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144733072 | 2017-11-14 | 2018-07-19 | 2422 DANVILLE RD SW STE H, DECATUR, AL, 356034221, US | 2422 DANVILLE RD SW STE H, DECATUR, AL, 356034221, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-353-1123 |
| Fax | 2562803551 |
Authorized person
| Name | SAMUEL COSTELLO |
| Role | PHARMACIST-IN CHARGE |
| Phone | 2563531123 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| License Number | 114750 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2171878 |
| Issuer | MEDICAID |
| Number | 1144733072 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| COSTELLO, SAMUEL M | Agent | 3220 HWY 31 SOUTH BLDG A-2DECATUR, AL 35603 |
| Name | Role | Address |
|---|---|---|
| COSTELLO, SAMUEL M | Director | 3220 HWY 31 SOUTH BLDG A-2DECATUR, AL 35603 |
| Name | Role | Address |
|---|---|---|
| COSTELLO, SAMUEL M | Incorporator | 3220 HWY 31 SOUTH BLDG A-2DECATUR, AL 35603 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2017-09-01 | Name Change | PILLBOX EXPRESS, INC. | LEGACY COMPOUNDING, INC. |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
