| Name: | Affinity MTM, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 13 May 2016 (8 years ago) |
| Date of dissolution: | 07 Jan 2022 |
| Entity Number: | 000-362-525 |
| Register Number: | 000362525 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 201 BEACON PKWY W STE 400BIRMINGHAM, AL 35209 |
| Registered Office Street Address ZIP Code: | 35209 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205372232 | 2017-01-14 | 2017-01-14 | 501 RIVERCHASE PKWY E, SUITE 201, HOOVER, AL, 352441808, US | 501 RIVERCHASE PKWY E, SUITE 201, HOOVER, AL, 352441808, US | |||||||||||||||||||||||||
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| Phone | +1 205-876-2658 |
| Fax | 8882053826 |
Authorized person
| Name | MRS. MICHELLE MALY |
| Role | OWNER/PHARMACIST |
| Phone | 2058762658 |
Taxonomy
| Taxonomy Code | 1835P0018X - Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| License Number | 800017 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PHARMACY CONSULTING |
| Number | 800017 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| ELLIS, WILLIAM A | Agent | 4900 GREAT OAK CIRCLEBIRMINGHAM, AL 35223 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
