Name: | Custom Pharmacy Solutions, LLC |
Jurisdiction: | Alabama |
Legal type: | Domestic Limited Liability Company |
Status: | Dissolved |
Date of registration: | 08 Jan 2007 (18 years ago) |
Date of dissolution: | 05 Mar 2018 |
Entity Number: | 000-488-449 |
Register Number: | 000488449 |
County: | Jefferson |
Place of Formation: | Jefferson County |
Principal Address: | HOMEWOOD, AL |
Registered Office Street Address: | 1821 27TH AVE SOUTHHOMEWOOD, AL 35209 |
Registered Office Street Address ZIP Code: | 35209 |
Activities
PHARMACEUTICAL OPERATION
Type | Company Name | Company Number | State |
---|---|---|---|
Headquarter of | Custom Pharmacy Solutions, LLC | 1088961 | CONNECTICUT |
Headquarter of | Custom Pharmacy Solutions, LLC | 0844278 | KENTUCKY |
Headquarter of | Custom Pharmacy Solutions, LLC | LLC_03573222 | ILLINOIS |
Headquarter of | Custom Pharmacy Solutions, LLC | 90e52e89-0730-e211-bc43-001ec94ffe7f | MINNESOTA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1902949068 | 2007-02-15 | 2015-07-17 | 2637 VALLEYDALE RD, HOOVER, AL, 352442075, US | 2637 VALLEYDALE RD, HOOVER, AL, 352442075, US | |||||||||||||||||||||||||||||
|
Phone | +1 205-988-3383 |
Fax | 2059883553 |
Fax | 2029883553 |
Authorized person
Name | LAURIE DICKINSON |
Role | PHARMACIST IN CHARGE |
Phone | 2059883383 |
Taxonomy
Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
License Number | 112911 |
State | AL |
Is Primary | Yes |
Taxonomy Code | 3336C0004X - Compounding Pharmacy |
Is Primary | No |
Other Provider Identifiers
Issuer | PK |
Number | 1996004 |
Name | Role | Address |
---|---|---|
KUCKENS, EDWARD H | Member | 3121 BLUE LAKE DRIVE SUITE 101VESTAVIA, AL 35243 |
ROBERTS, KENNETH T | Member | No data |
Name | Role | Address |
---|---|---|
KUCKENS, EDWARD H | Agent | 3121 BLUE LAKE DRIVE SUITE 101VESTAVIA, AL 35243 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State