| Name: | Brenncorp, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 13 Nov 1984 (40 years ago) |
| Date of dissolution: | 10 Aug 2011 |
| Entity Number: | 000-100-992 |
| Register Number: | 000100992 |
| ZIP code: | 36602 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 2408 1ST NATIONAL BANK BLDGMOBILE, AL 36602 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $1,000 |
Activities
PHARMACEUTICAL SUPPLIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881768307 | 2006-11-17 | 2010-08-23 | 2152 AIRPORT BLVD, MOBILE, AL, 366061756, US | 2152 AIRPORT BLVD, MOBILE, AL, 366061756, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 251-479-2424 |
| Fax | 2514795234 |
Authorized person
| Name | MARSHALL WATERS |
| Role | PRES |
| Phone | 2517392424 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 109668 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 0119366 |
| Issuer | MEDICAID |
| Number | 100002231 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRENNCORP, INC. PROFIT SHARING PLAN | 2010 | 630902925 | 2011-11-14 | BRENNCORP, INC. | 3 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 630902925 |
| Plan administrator’s name | BRENNCORP, INC. |
| Plan administrator’s address | 2152 AIRPORT BLVD, SUITE 107, MOBILE, AL, 366061751 |
| Administrator’s telephone number | 2514792424 |
Signature of
| Role | Plan administrator |
| Date | 2011-11-14 |
| Name of individual signing | MARSHALL L. WATERS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2001-07-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 2514792424 |
| Plan sponsor’s address | 2152 AIRPORT BLVD, SUITE 107, MOBILE, AL, 366061751 |
Plan administrator’s name and address
| Administrator’s EIN | 630902925 |
| Plan administrator’s name | BRENNCORP, INC. |
| Plan administrator’s address | 2152 AIRPORT BLVD, SUITE 107, MOBILE, AL, 366061751 |
| Administrator’s telephone number | 2514792424 |
Signature of
| Role | Plan administrator |
| Date | 2011-01-05 |
| Name of individual signing | MARSHALL L. WATERS |
| Name | Role |
|---|---|
| BRILES, ANNIE FRANK | Agent |
| Name | Role |
|---|---|
| BRILES, ANNIE FRANK | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
