| Name: | Double Springs Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 17 Aug 2016 (8 years ago) (Companies founded in August 2016) |
| Entity Number: | 000-369-543 |
| Register Number: | 000369543 |
| ZIP code: | 36375 (Companies in Geneva, 36375) |
| County: | Geneva |
| Place of Formation: | Geneva County |
| Registered Office Street Address: | 141 SOUTH DALTON STREETSLOCOMB, AL 36375 |
| Registered Office Mailing Address: | POST OFFICE BOX 279SLOCOMB, AL 36375 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508313800 | 2016-09-02 | 2024-08-27 | 300 N DEAN RD SUITE 5, PMB 202, AUBURN, AL, 36830, US | 26289 HIGHWAY 195, DOUBLE SPRINGS, AL, 355532554, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-886-2442 |
| Fax | 3348867442 |
| Phone | +1 205-489-2572 |
| Fax | 2054893722 |
Authorized person
| Name | JOE DALTON |
| Role | OWNER |
| Phone | 2054892572 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114657 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 192145 |
| State | AL |
| Issuer | PK |
| Number | 2164140 |
| Name | Role | Address |
|---|---|---|
| DALTON, JOE A | Agent | 141 SIYTG DAKTIB STREETSLOCOMB, AL 36375 |
| Name | Role | Address |
|---|---|---|
| HINESLEY, WILLIAM W | Organizer | 291 NORTH OATES STEETDOTHAN, AL 36302 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
