| Name: | DIXIE INDEPENDENT ENTERPRISES, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 10 Jun 2020 (4 years ago) |
| Entity Number: | 000-634-198 |
| Register Number: | 000634198 |
| County: | Cullman |
| Place of Formation: | Cullman County |
| Registered Office Street Address: | 150 COUNTY ROAD 676CULLMAN, AL 35055 |
| Registered Office Street Address ZIP Code: | 35055 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780024679 | 2013-06-25 | 2020-12-04 | PO BOX 7, ALTOONA, AL, 35952, US | 7101 ETOWAH ST, ALTOONA, AL, 35952, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 205-589-6557 |
| Fax | 2055896553 |
Authorized person
| Name | DR. GABRIEL ARGO |
| Role | OWER |
| Phone | 2055896557 |
Taxonomy
| Taxonomy Code | 183500000X - Pharmacist |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 101165 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100001368 |
| State | AL |
| Name | Role |
|---|---|
| ARGO, GABRIEL C | Agent |
| Name | Role | Address |
|---|---|---|
| ARGO, GABRIEL CAIN | Organizer | 150 COUNTY ROAD 676CULLMAN, AL 35055 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
