| Name: | Mills Pharmacy at Eutaw, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Apr 2018 (7 years ago) (Companies founded in April 2018) |
| Entity Number: | 000-515-160 |
| Register Number: | 000515160 |
| ZIP code: | 35226 (Companies in Jefferson, 35226) |
| County: | Jefferson |
| Place of Formation: | Greene County |
| Registered Office Street Address: | 2400 MTN DRIVE STE 104HOOVER, AL 35226 |
| Registered Office Mailing Address: | PO BOX 26679BIRMINGHAM, AL 35260 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750870598 | 2018-05-08 | 2020-04-10 | PO BOX 26679, BIRMINGHAM, AL, 352600679, US | 306 MORROW AVE, EUTAW, AL, 354621108, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-871-9007 |
| Fax | 2058749946 |
| Phone | +1 205-372-0500 |
| Fax | 2053720015 |
Authorized person
| Name | JOSH HARDIN |
| Role | OWNER |
| Phone | 2054270955 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 114808 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2177532 |
| Issuer | MEDICAID |
| Number | 215422 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| LONG, BEETINA | Agent | 2087 BANEBERRY DRHOOVER, AL 35244 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
