| Name: | New Grand Bay Pharmacy, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 Jul 2010 (14 years ago) |
| Entity Number: | 000-449-965 |
| Register Number: | 000449965 |
| ZIP code: | 36541 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Registered Office Street Address: | 12475 US HWY 90GRAND BAY, AL 36541 |
| Principal Address: | GRAND BAY, AL |
Activities
PHARMACY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467766865 | 2010-07-28 | 2024-10-18 | PO BOX 129, GRAND BAY, AL, 365410129, US | 10067 GRAND BAY WILMER RD S, GRAND BAY, AL, 365415003, US | |||||||||||||||||||||||||||||
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| Phone | +1 251-865-1040 |
| Fax | 2518651041 |
| Phone | +1 251-865-5555 |
| Fax | 2518653785 |
Authorized person
| Name | MR. CHARLES D COTTRELL |
| Role | PRESIDENT |
| Phone | 2518655555 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113415 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 121508 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| COTTRELL, CHARLES D | Agent | 810 EAST CRAIG STREETATMORE, AL 36502 |
| Name | Role | Address |
|---|---|---|
| COTTRELL, CHARLES D | Member | 810 EAST CRAIG STREETATMORE, AL 36502 |
| VANN, JAMES F | Member | No data |
| COTTRELL, TIMOTHY | Member | No data |
| COTTRELL, RONALD W | Member | No data |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
