| Name: | Fyffe Pharmacy, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 10 Jan 2007 (18 years ago) (Companies founded in January 2007) |
| Entity Number: | 000-488-679 |
| Register Number: | 000488679 |
| ZIP code: | 35971 (Companies in De Kalb, 35971) |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Principal Address: | FYFFE, AL |
| Registered Office Street Address: | 44 BLACKWELL STFYFFE, AL 35971 |
Activities
DRUG STORE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043366800 | 2007-01-26 | 2008-04-28 | PO BOX 67, FYFFE, AL, 359710067, US | 44 BLACKWELL ST., FYFFE, AL, 359710067, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-623-2944 |
| Fax | 2566233938 |
Authorized person
| Name | MR. BRANDON L. RAINS |
| Role | OWNER |
| Phone | 2566232944 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 104223 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP |
| Number | 0106852 |
| State | AL |
| Issuer | MEDICAID DME |
| Number | 009911130 |
| State | AL |
| Issuer | MEDICARE PART B IMMUNIZATION PROVIDER NUMBER |
| Number | 510G730002 |
| State | AL |
| Issuer | MEDICAID |
| Number | 100003781 |
| State | AL |
| Name | Role |
|---|---|
| RAINS, BRANDON | Member |
| Name | Role |
|---|---|
| RAINS, BRANDON | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
