| Name: | Medistat RX, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 20 Dec 2007 (17 years ago) |
| Date of dissolution: | 10 Nov 2016 |
| Entity Number: | 000-413-846 |
| Register Number: | 000413846 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 350 CYPRESS BEND DR BLDG FGULF SHORES, AL 36542 |
| Registered Office Street Address ZIP Code: | 36542 |
Activities
PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366627770 | 2008-01-03 | 2014-12-19 | 110 E AZALEA AVE, FOLEY, AL, 365352540, US | 110 E AZALEA AVE, FOLEY, AL, 365352540, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 855-737-2550 |
| Fax | 8663102803 |
| Phone | +1 251-923-2525 |
Authorized person
| Name | MARK ACKER |
| Role | CEO |
| Phone | 8557372550 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| License Number | 113031 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 1996235 |
| Name | Role | Address |
|---|---|---|
| ACKER, MARK | Agent | 21775 HIGHWAY 98FOLEY, AL 36535 |
| Name | Role | Address |
|---|---|---|
| ACKER, MARK D | Member | 350 CYPRESS BEND DRIVE BLDG FGULF SHORES, AL 36542 |
| NEWMAN, DANIEL A | Member | 350 CYPRESS BEND DRIVE BLDG FGULF SHORES, AL 36542 |
| FICKLING, TIMOTHY L | Member | 350 CYPRESS BEND DRIVE BLDG FGULF SHORES, AL 36542 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
