| Name: | Corbett's Pharmacy LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 Aug 2024 (8 months ago) |
| Entity Number: | 001-151-161 |
| Register Number: | 001151161 |
| ZIP code: | 35555 |
| County: | Fayette |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 1716 Temple Avenue North, Suite 1Fayette, AL 35555 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881956662 | 2012-06-08 | 2024-10-11 | 1716 TEMPLE AVE N, FAYETTE, AL, 355551309, US | 1716 TEMPLE AVE N, FAYETTE, AL, 355551309, US | |||||||||||||||||||||||||||
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| Phone | +1 205-932-7455 |
| Fax | 2059323040 |
Authorized person
| Name | MRS. BRANDI CORBETT |
| Role | OWNER |
| Phone | 2059327455 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 113918 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 0137960 |
| Name | Role |
|---|---|
| Corbett, Brandi | Agent |
| Name | Role | Address |
|---|---|---|
| Macoy, Mark W | Organizer | 300 Vestavia Parkway, Suite 2300Vestavia Hills, AL 35216 |
Date of last update: 05 Sep 2024
Sources: Alabama Secretary of State
