| Name: | ICPM, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Series Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Nov 2019 (5 years ago) |
| Entity Number: | 000-594-318 |
| Register Number: | 000594318 |
| ZIP code: | 35243 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 3633 ALTADENA DRIVEVESTAVIA, AL 35243 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316021041 | 2006-10-25 | 2020-06-25 | PO BOX 1165, 914 7TH ST SO, CLANTON, AL, 350461165, US | 914 7TH ST SO, CLANTON, AL, 350461165, US | |||||||||||||||||||||||||
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| Phone | +1 205-755-8009 |
| Fax | 2057555250 |
Authorized person
| Name | DARREN C MORTON |
| Role | OWNER |
| Phone | 2057558009 |
Taxonomy
| Taxonomy Code | 183500000X - Pharmacist |
| License Number | 22795 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100001944 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| JACKSON, BRAD | Agent | 3633 ALTADENA DRIVEVESTAVIA, AL 35243 |
| Name | Role | Address |
|---|---|---|
| JACKSON, BRAD | Organizer | 3633 ALTADENA DRIVEVESTAVIA, AL 35243 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
