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  5. PARK SHORE DRUG, INC.

PARK SHORE DRUG, INC.

Company Details

Entity Name: PARK SHORE DRUG, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 13 Nov 1958 (66 years ago)
Document Number: 217224
FEI/EIN Number 590870901
Address: 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009, US
Mail Address: 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009, US
ZIP code: 33009
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1063595932 2006-10-23 2010-07-19 9531 NE 2ND AVE, MIAMI SHORES, FL, 331382704, US 9531 NE 2ND AVE, MIAMI SHORES, FL, 331382704, US

Contacts
Phone +1 305-754-9508
Fax 3057543512

Authorized person
Name MR. ROBERT D GILLIS
Role V.P.
Phone 3057549508

Taxonomy
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
License Number PH0000863
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 671982104
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PARK SHORE DRUG INC 401(K) PROFIT SHARING PLAN & TRUST 2023 590870901 2024-07-02 PARK SHORE DRUG INC 101
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2024-07-02
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401(K) PROFIT SHARING PLAN & TRUST 2022 590870901 2023-07-16 PARK SHORE DRUG INC 100
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2023-07-16
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401(K) PROFIT SHARING PLAN & TRUST 2021 590870901 2022-07-25 PARK SHORE DRUG INC 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2022-07-25
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401(K) PROFIT SHARING PLAN & TRUST 2020 590870901 2021-07-06 PARK SHORE DRUG INC 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2021-07-06
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401(K) PROFIT SHARING PLAN & TRUST 2019 590870901 2020-05-07 PARK SHORE DRUG INC 68
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2020-05-07
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401 K PROFIT SHARING PLAN TRUST 2018 590870901 2019-06-12 PARK SHORE DRUG INC 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2019-06-12
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401 K PROFIT SHARING PLAN TRUST 2017 590870901 2018-06-14 PARK SHORE DRUG INC 90
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2018-06-14
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401 K PROFIT SHARING PLAN TRUST 2016 590870901 2017-05-17 PARK SHORE DRUG INC 81
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2017-05-17
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401 K PROFIT SHARING PLAN TRUST 2015 590870901 2016-06-22 PARK SHORE DRUG INC 74
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2016-06-22
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature
PARK SHORE DRUG INC 401 K PROFIT SHARING PLAN TRUST 2014 590870901 2015-07-08 PARK SHORE DRUG INC 77
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 446110
Sponsor’s telephone number 9548744646
Plan sponsor’s address 600 ANSIN BLVD, HALLANDALE BEACH, FL, 330092118

Signature of
Role Plan administrator
Date 2015-07-08
Name of individual signing JOSEPHINE GILLIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ZEBERSKY PAYNE SHAW LEWENZ Agent 110 SOUTHEAST 6TH STREET, FORT LAUDERDALE, FL, 33301

President

Name Role Address
GILLIS ROBERT President 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009

Exec

Name Role Address
Gillis Josephine Exec 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009

Vice President

Name Role Address
Propper Steven Vice President 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009
Palanza Kristen Vice President 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009

Officer

Name Role Address
Propper Steven Officer 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009

Director

Name Role Address
Palanza Kristen Director 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009
KARKOS JILLIAN Director 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G17000019699 PARK SHORE PHARMACON ACTIVE 2017-02-22 2027-12-31 No data 600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009
G09000109601 PARK SHORE PHARMACY EXPIRED 2009-05-21 2014-12-31 No data 9531 NE 2ND AVENUE, MIAMI SHORES, FL, 33138
G09000109605 PARK SHORE PHARMACON EXPIRED 2009-05-21 2014-12-31 No data 9531-B NE 2ND AVENUE, MIAMI SHORES, FL, 33138

Events

Event Type Filed Date Value Description
AMENDED AND RESTATEDARTICLES/NAME CHANGE 2022-12-27 PARK SHORE DRUG, INC. No data
REINSTATEMENT 2002-10-25 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2002-10-04 No data No data

Related by officers

GILLIS ROBERT

RATITE MARKETING, INC. SEA OAKS BEACH & TENNIS CLUB, INC. LEHTE INDUSTRIES, LLC

ZEBERSKY PAYNE SHAW LEWENZ

PSD HOLDINGS, LLC PARK SHORE PHARMACY, LLC

Related by address

600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009, US

PSD HOLDINGS, LLC

600 ANSIN BOULEVARD, HALLANDALE BEACH, FL, 33009, US

PSD HOLDINGS, LLC

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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