| Name: | Harpersville Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Jul 2007 (17 years ago) |
| Entity Number: | 000-496-920 |
| Register Number: | 000496920 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 1078 KNOLLWOOD DRBIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
Activities
PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346434537 | 2007-08-30 | 2014-05-16 | 39321 HIGHWAY 25, SUITE 100, HARPERSVILLE, AL, 350784949, US | 39321 HIGHWAY 25, HARPERSVILLE, AL, 350784949, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 205-642-9222 |
| Fax | 2056429224 |
Authorized person
| Name | PAUL DEICHMANN |
| Role | OWNER |
| Phone | 2056429300 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 112982 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 10039185 |
| State | AL |
| Issuer | PK |
| Number | 1996167 |
| Name | Role |
|---|---|
| DEICHMANN, PAUL C | Member |
| Name | Role |
|---|---|
| DEICHMANN, PAUL C | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
