| Name: | AJ Pharmacy LLC store 02 |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 16 Feb 2022 (3 years ago) |
| Identification Number: | 001736207 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 468 SMITHFIELD RD, NORTH PROVIDENCE, RI, 02904, USA |
| Mailing Address: | 105 RESERVOIR ROAD, COVENTRY, RI, 02816, USA |
| Purpose: | RETAIL PHARMACY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003561655 | 2022-02-12 | 2022-09-08 | 1017 SMITH ST, PROVIDENCE, RI, 029082747, US | 468 SMITHFIELD RD, NORTH PROVIDENCE, RI, 029044266, US | |||||||||||||||||||
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| Phone | +1 401-366-2800 |
Authorized person
| Name | CHARLES AGWUNOBI |
| Role | OWNER |
| Phone | 4014995427 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000000 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CHARLES AGWUNOBI | Agent | 105 RESERVOIR RD, COVENTRY, RI, 02816, USA |
| Number | Name | File Date |
|---|---|---|
| 202447326330 | Annual Report | 2024-02-26 |
| 202447326420 | Annual Report | 2024-02-26 |
| 202447326060 | Reinstatement | 2024-02-26 |
| 202341166500 | Revocation Certificate For Failure to File the Annual Report for the Year | 2023-09-11 |
| 202337715110 | Revocation Notice For Failure to File An Annual Report | 2023-06-16 |
| 202210908930 | Articles of Organization | 2022-02-16 |
Date of last update: 28 Oct 2024
Sources: Rhode Island Department of State
