| Name: | North Baldwin Family Pharmacy, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 Oct 1996 (28 years ago) |
| Entity Number: | 000-654-986 |
| Register Number: | 000654986 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 2012 HAND AVEBAY MINETTE, AL 36507 |
| Registered Office Street Address ZIP Code: | 36507 |
| Principal Address: | BAY MINETTE, AL 36507 |
| Principal Address ZIP Code: | 36507 |
Activities
PHARMACY BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780650911 | 2006-02-27 | 2022-05-23 | 2012 HAND AVE, BAY MINETTE, AL, 365074115, US | 2012 HAND AVE, BAY MINETTE, AL, 365074115, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 251-937-9623 |
| Fax | 2519372250 |
Authorized person
| Name | MRS. JANET GREEN CHASTANG |
| Role | PHARMACIST |
| Phone | 2519379623 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 4305 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009969140 |
| State | AL |
| Issuer | MEDICAID |
| Number | 100000087 |
| State | AL |
| Name | Role |
|---|---|
| CHASTANG, JANET G | Agent |
| Name | Role | Address |
|---|---|---|
| JUSTICE, W J | Member | No data |
| COTTRELL, CHARLES D | Member | 810 EAST CRAIG STREETATMORE, AL 36502 |
| PATRICK, FERRELL | Member | No data |
| CHASTANG, JANET G | Member | No data |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
