| Name: | Trussville Total Care Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Mar 2010 (15 years ago) |
| Entity Number: | 000-444-167 |
| Register Number: | 000444167 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | TRUSSVILLE, AL |
| Registered Office Street Address: | 6187 LONGMEADOW COURTTRUSSVILLE, AL 35173 |
| Registered Office Street Address ZIP Code: | 35173 |
Activities
RETAIL PHARMACEUTICAL ESTABLISHMENT
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154642304 | 2010-06-22 | 2019-01-15 | PO BOX 252, CLAY, AL, 350480252, US | 115 N CHALKVILLE RD, TRUSSVILLE, AL, 351731376, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-655-3455 |
| Fax | 2056553425 |
Authorized person
| Name | GREG CARROLL |
| Role | OWNER |
| Phone | 2056805557 |
Taxonomy
| Taxonomy Code | 163WD0400X - Diabetes Educator Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113409 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2125450 |
| Issuer | MEDICAID |
| Number | 000120600 |
| State | AL |
| Name | Role |
|---|---|
| CARROLL, GREGORY WADE | Agent |
| Name | Role |
|---|---|
| CARROLL, GREGORY WADE | Member |
| BROOME, JAMES MICHAEL | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
