| Entity Name: | JAY PHARMACY OF JAY, FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Apr 1968 (57 years ago) |
| Document Number: | 328940 |
| FEI/EIN Number | 591227412 |
| Address: | 14088 ALABAMA ST, JAY, FL, 32565, US |
| Mail Address: | 362 Gulf Breeze Pkwy, #121, Gulf Breeze, FL, 32561, US |
| ZIP code: | 32565 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | JAY PHARMACY OF JAY, FLORIDA, INC., ALABAMA | 000-339-124 | ALABAMA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467597799 | 2007-02-21 | 2017-01-18 | PO BOX 367, JAY, FL, 325650367, US | 14088 ALABAMA ST, JAY, FL, 325651036, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 850-675-6666 |
| Fax | 8506754006 |
| Fax | 8506754666 |
Authorized person
| Name | JOEY HART |
| Role | PHARMACY MANAGER |
| Phone | 8506756666 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH2540 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2004944 |
| Issuer | MEDICAID |
| Number | 101481100 |
| State | FL |
| Name | Role |
|---|---|
| PERDIDO BAY LLC | Agent |
| Name | Role | Address |
|---|---|---|
| WINGETT CARLTON | Secretary | 38 SOUTH BLUE ANGEL PKWY #169, PENSACOLA, FL, 32506 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000009235 | JAY PHARMACY OF JAY FLA | EXPIRED | 2016-01-25 | 2021-12-31 | No data | 707 CERVANTES STREET, PENSACOLA, FL, 32565 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| AMENDMENT | 2016-07-07 | No data | No data |
| AMENDMENT | 2005-09-19 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
