| Name: | Fort Williams Pharmacy, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 May 2009 (15 years ago) |
| Entity Number: | 000-433-839 |
| Register Number: | 000433839 |
| County: | Shelby |
| Place of Formation: | Talladega County |
| Principal Address: | CHELSEA, AL |
| Registered Office Street Address: | 639 SHELBY FOREST TRAILCHELSEA, AL 35043 |
| Registered Office Street Address ZIP Code: | 35043 |
Activities
RETAIL PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689808917 | 2009-05-14 | 2017-02-16 | 401 W FORT WILLIAMS ST, SYLACAUGA, AL, 351502435, US | 401 W FORT WILLIAMS ST, SYLACAUGA, AL, 351502435, US | |||||||||||||||||||||||||||
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| Phone | +1 256-207-2007 |
| Fax | 2562072008 |
Authorized person
| Name | CHAD LIGHTSEY |
| Role | OWNER |
| Phone | 2564046165 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113273 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2120344 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FORT WILLIAMS PHARMACY (WELFARE PLAN) | 2022 | 901943640 | 2023-07-27 | FORT WILLIAMS PHARMACY | 0 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 472506773 |
| Plan administrator’s name | KENNION & CO LLC |
| Plan administrator’s address | 2828 OLD 280 COURT STE 110, VESTAVIA, AL, 35243 |
| Administrator’s telephone number | 8669665457 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-19 |
| Name of individual signing | W. HAL SHEPHERD |
| Role | Employer/plan sponsor |
| Date | 2023-07-19 |
| Name of individual signing | W. HAL SHEPHERD |
| Name | Role |
|---|---|
| LIGHTSEY, CHAD ANTHONY | Agent |
| Name | Role |
|---|---|
| LIGHTSEY, CHAD ANTHONY | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
