| Name: | Gadsden Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 Jul 2004 (20 years ago) (Companies founded in July 2004) |
| Entity Number: | 000-453-688 |
| Register Number: | 000453688 |
| ZIP code: | 35906 (Companies in Etowah, 35906) |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Principal Address: | RAINBOW CITY, AL |
| Registered Office Street Address: | 212 HUMMINGBIRD WAYRAINBOW CITY, AL 35906 |
Activities
OWN/OPERATE/MANAGE A PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720078447 | 2005-10-25 | 2019-10-04 | 911 RAINBOW DR, GADSDEN, AL, 359015309, US | 911 RAINBOW DR, GADSDEN, AL, 359015309, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-547-4479 |
| Fax | 2565490577 |
Authorized person
| Name | MRS. MELISSA ANN LESLIE |
| Role | PHARMACIST OWNER |
| Phone | 2565474479 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 10003590 |
| State | AL |
| Issuer | STATE BOARD OF PHARMACY |
| Number | 112564 |
| State | AL |
| Issuer | NCPDP |
| Number | 0132706 |
| State | AL |
| Name | Role |
|---|---|
| LESLIE, GLENN | Agent |
| Name | Role |
|---|---|
| LESLIE, GLENN | Member |
| LESLIE, MELISSA | Member |
| TUMMALA, PHANIRAJAKUMARI | Member |
| TUMMALA, VIJAYAPRASAD | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
