| Name: | Bayou Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 09 Oct 2009 (15 years ago) (Companies founded in October 2009) |
| Entity Number: | 000-439-011 |
| Register Number: | 000439011 |
| ZIP code: | 36509 (Companies in Mobile, 36509) |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | BAYOU LA BATRE, AL |
| Registered Office Street Address: | 13240 NORTH WINTZELL AVEBAYOU LA BATRE, AL 36509 |
Activities
PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629304183 | 2009-10-19 | 2017-03-16 | 12855 PADGETT SWITCH RD, IRVINGTON, AL, 365444015, US | 12855 PADGETT SWITCH RD, IRVINGTON, AL, 365444015, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 251-824-7979 |
| Fax | 2518247989 |
Authorized person
| Name | CHARLES COTTRELL |
| Role | PRESIDENT/PHARMACIST |
| Phone | 2518247979 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113326 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114666 |
| State | AL |
| Issuer | PK |
| Number | 2122525 |
| Name | Role |
|---|---|
| COTTRELL, JEAN L | Agent |
| Name | Role | Address |
|---|---|---|
| COTTRELL, CHARLES D | Member | 810 EAST CRAIG STREETATMORE, AL 36502 |
| COTTRELL, KAREN D | Member | No data |
| COTTRELL, JEAN L | Member | No data |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
