| Name: | Dothan Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 04 Oct 2017 (7 years ago) |
| Entity Number: | 000-404-669 |
| Register Number: | 000404669 |
| County: | Houston |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 301 W INEZ ROAD SUITE 8DOTHAN, AL 36301 |
| Registered Office Street Address ZIP Code: | 36301 |
| Authorized Capital: | 1000 @ $1.00 PV |
Activities
RETAIL PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760996573 | 2017-12-01 | 2021-10-04 | 301 W INEZ RD STE 8, DOTHAN, AL, 363015678, US | 301 W INEZ RD STE 8, DOTHAN, AL, 363015678, US | |||||||||||||||||||||||||||||
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| Phone | +1 334-479-8448 |
| Fax | 3344798108 |
Authorized person
| Name | MARVIN COOK |
| Role | OWNER/PHARMACIST |
| Phone | 3344798448 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114767 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2174323 |
| Issuer | MEDICAID |
| Number | 207314 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| COOK, W MARVIN JR | Director | 664 WESTBROOK ROADDOTHAN, AL 36303 |
| COOK, V RENEE | Director | 664 WESTBROOK ROADDOTHAN, AL 36303 |
| NORTH, BRIAN S | Director | 773 JOHNNY MURPHY ROADDOTHAN, AL 36301 |
| NORTH, BREANNA M | Director | 773 JOHNNY MURPHY ROADDOTHAN, AL 36301 |
| Name | Role | Address |
|---|---|---|
| COOK, W M JR | Incorporator | 664 WESTBROOK ROADDOTHAN, AL 36303 |
| Name | Role | Address |
|---|---|---|
| COOK, W M JR | Agent | 664 WESTBROOK ROADDOTHAN, AL 36303 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
