| Entity Name: | WAAS DRUG STORE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Dec 1959 (65 years ago) |
| Document Number: | 231559 |
| FEI/EIN Number | 590879016 |
| Address: | 1551 SOUTH 14TH STREET, FERNANDINA BEACH, FL, 32034 |
| Mail Address: | 1551 SOUTH 14TH STREET, FERNANDINA BEACH, FL, 32034 |
| ZIP code: | 32034 |
| County: | Nassau |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104994342 | 2006-12-04 | 2016-09-29 | PO BOX 518, FERNANDINA BEACH, FL, 320350518, US | 1551 S 14TH ST, STE 1, FERNANDINA BEACH, FL, 320341930, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 904-261-3171 |
| Fax | 9043210685 |
Authorized person
| Name | JAMES PARKER |
| Role | PRES |
| Phone | 9042613171 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH1804 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102064100 |
| State | FL |
| Issuer | PK |
| Number | 2004149 |
| Name | Role |
|---|---|
| COURSON & STAM LLC | Agent |
| Name | Role | Address |
|---|---|---|
| Kotopka Katherine | President | 1551 SOUTH 14TH STREET, FERNANDINA BEACH, FL, 32034 |
| Name | Role | Address |
|---|---|---|
| Kotopka Katherine | Director | 1551 SOUTH 14TH STREET, FERNANDINA BEACH, FL, 32034 |
| Name | Role | Address |
|---|---|---|
| PARKER James W | Treasurer | 20 SOUTH STREET, FERNANDINA BCH, FL |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
