| Name: | Custom Pharmacy Solutions, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 08 Jan 2007 (18 years ago) |
| Date of dissolution: | 05 Mar 2018 |
| Entity Number: | 000-488-449 |
| Register Number: | 000488449 |
| ZIP code: | 35209 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | HOMEWOOD, AL |
| Registered Office Street Address: | 1821 27TH AVE SOUTHHOMEWOOD, AL 35209 |
Activities
PHARMACEUTICAL OPERATION
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | Custom Pharmacy Solutions, LLC, MINNESOTA | 90e52e89-0730-e211-bc43-001ec94ffe7f | MINNESOTA |
| Headquarter of | Custom Pharmacy Solutions, LLC, KENTUCKY | 0844278 | KENTUCKY |
| Headquarter of | Custom Pharmacy Solutions, LLC, CONNECTICUT | 1088961 | CONNECTICUT |
| Headquarter of | Custom Pharmacy Solutions, LLC, ILLINOIS | LLC_03573222 | ILLINOIS |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902949068 | 2007-02-15 | 2015-07-17 | 2637 VALLEYDALE RD, HOOVER, AL, 352442075, US | 2637 VALLEYDALE RD, HOOVER, AL, 352442075, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 205-988-3383 |
| Fax | 2059883553 |
| Fax | 2029883553 |
Authorized person
| Name | LAURIE DICKINSON |
| Role | PHARMACIST IN CHARGE |
| Phone | 2059883383 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 112911 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 1996004 |
| Name | Role | Address |
|---|---|---|
| KUCKENS, EDWARD H | Member | 3121 BLUE LAKE DRIVE SUITE 101VESTAVIA, AL 35243 |
| ROBERTS, KENNETH T | Member | No data |
| Name | Role | Address |
|---|---|---|
| KUCKENS, EDWARD H | Agent | 3121 BLUE LAKE DRIVE SUITE 101VESTAVIA, AL 35243 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
