| Name: | Eastern Shore Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Feb 2017 (8 years ago) |
| Entity Number: | 000-384-553 |
| Register Number: | 000384553 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 20489 STATE HWY 181FAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376060798 | 2017-08-25 | 2021-10-20 | 20489 STATE HWY 181, FAIRHOPE, AL, 36532, US | 20489 STATE HIGHWAY 181, FAIRHOPE, AL, 365324369, US | |||||||||||||||||||||||||
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| Phone | +1 251-928-9073 |
| Fax | 2519289075 |
Authorized person
| Name | MR. STEVEN WESLEY GIFFORD |
| Role | OWNER/PHARMACIST |
| Phone | 2055296654 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114739 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 209787 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| GIFFORD, STEVEN W | Agent | 20489 STATE HWY 181FAIRHOPE, AL 36532 |
| Name | Role | Address |
|---|---|---|
| GIFFORD, STEVEN W | Organizer | 20489 STATE HWY 181FAIRHOPE, AL 36532 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
