| Name: | Fayette Pharmacy, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 11 Mar 2008 (17 years ago) |
| Entity Number: | 000-256-483 |
| Register Number: | 000256483 |
| ZIP code: | 35555 |
| County: | Fayette |
| Place of Formation: | Fayette County |
| Principal Address: | FAYETTE, AL |
| Registered Office Street Address: | 1128 2ND AVE NEFAYETTE, AL 35555 |
| Authorized Capital: | $25,000 |
| Paid Share Capital: | $1,000 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114191459 | 2008-04-17 | 2011-07-26 | 1128 2ND AVE NE, FAYETTE, AL, 355551739, US | 1128 2ND AVE NE, FAYETTE, AL, 355551739, US | |||||||||||||||||||||||
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| Phone | +1 205-932-5400 |
| Fax | 2059325401 |
Authorized person
| Name | SUMMER WILSON |
| Role | PHRMD |
| Phone | 2057121685 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113087 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 0135233 |
| Name | Role | Address |
|---|---|---|
| WILSON, SUMMER | Incorporator | 106 SPRINGHILL ROADMILLPORT, AL 35576 |
| WILSON, BARRY | Incorporator | 106 SPRINGHILL ROADMILLPORT, AL 35576 |
| Name | Role | Address |
|---|---|---|
| WILSON, BARRY | Agent | 106 SPRINGHILL ROADMILLPORT, AL 35576 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3538137200 | 2020-04-27 | 0459 | PPP | 13532 Highway 96, Millport, AL, 35776-2522 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
