| Name: | Gulf Coast Pharmacy LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 03 Apr 2008 (17 years ago) (Companies founded in April 2008) |
| Date of dissolution: | 13 Dec 2012 |
| Entity Number: | 000-418-539 |
| Register Number: | 000418539 |
| ZIP code: | 36609 (Companies in Mobile, 36609) |
| County: | Mobile |
| Place of Formation: | Jefferson County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 515 AZALEA ROADMOBILE, AL 36609 |
Activities
PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184917429 | 2011-05-19 | 2011-09-27 | 515 AZALEA RD, MOBILE, AL, 366091501, US | 515 AZALEA RD, MOBILE, AL, 366091501, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 251-342-5519 |
Authorized person
| Name | DAVID BUSH |
| Role | PHARMACIST |
| Phone | 2514043343 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113142 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336M0002X - Mail Order Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336N0007X - Nuclear Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 0137162 |
| Name | Role | Address |
|---|---|---|
| BUSH, DAVID | Agent | 1900 SHELTON BEACH ROAD EXT APT1112MOBILE, AL 36618 |
| Name | Role |
|---|---|
| BUSH, JAMES | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
