| Name: | Pisgah Family Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 31 Jul 2006 (18 years ago) |
| Entity Number: | 000-482-212 |
| Register Number: | 000482212 |
| County: | Jackson |
| Place of Formation: | Jackson County |
| Principal Address: | SCOTTSBORO, AL |
| Registered Office Street Address: | 201 VETERANS DRSCOTTSBORO, AL 35768 |
| Registered Office Street Address ZIP Code: | 35768 |
Activities
DRUG STORE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861586125 | 2006-10-03 | 2014-02-07 | PO BOX 9, PISGAH, AL, 357650009, US | 6049 COUNTY ROAD 88, PISGAH, AL, 35765, US | |||||||||||||||||||||||||||||
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| Phone | +1 256-451-3283 |
| Fax | 2564516088 |
Authorized person
| Name | STEVEN OVERBY |
| Role | OWNER |
| Phone | 2564513283 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 107810 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100003760 |
| State | AL |
| Issuer | PK |
| Number | 1988899 |
| Name | Role |
|---|---|
| CARROLL, JOEL K | Agent |
| Name | Role | Address |
|---|---|---|
| CARROLL, JOEL K | Member | No data |
| HILL, JEFFREY | Member | 3024 LARKSPUR LANEHELENA, AL 35022 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
