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  5. ATKINSON'S MART, INC.

ATKINSON'S MART, INC.

Company Details

Entity Name: ATKINSON'S MART, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 01 Aug 1969 (55 years ago)
Document Number: 350227
FEI/EIN Number 591275590
Address: 1994-A KINGSLEY AVE, ORANGE PARK, FL, 32073, US
Mail Address: 1994-A KINGSLEY AVE, ORANGE PARK, FL, 32073, US
ZIP code: 32073
County: Clay
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1265500672 2006-12-01 2015-02-02 1994 KINGSLEY AVE STE A, ORANGE PARK, FL, 320734465, US 1994 KINGSLEY AVE, ORANGE PARK, FL, 320734442, US

Contacts
Phone +1 904-298-0873

Authorized person
Name MR. KEVIN WILEY DAVIS
Role OWNER
Phone 9042980873

Taxonomy
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary No
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
License Number PH17156
State FL
Is Primary Yes
Taxonomy Code 3336C0004X - Compounding Pharmacy
License Number PH28421
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 101585100
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2023 591275590 2024-06-11 ATKINSON'S MART, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042980873
Plan sponsor’s address 1994-A KINGSLEY AVENUE, ORANGE PARK, FL, 320733003

Signature of
Role Plan administrator
Date 2024-06-11
Name of individual signing KIMBERLY DEAL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-06-11
Name of individual signing KIMBERLY DEAL
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2022 591275590 2023-06-21 ATKINSON'S MART, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 1994-A KINGSLEY AVENUE, ORANGE PARK, FL, 320733003

Signature of
Role Plan administrator
Date 2023-06-21
Name of individual signing KIMBERLY D DEAL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-06-21
Name of individual signing KIMBERLY D DEAL
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2021 591275590 2022-06-15 ATKINSON'S MART, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 1994-A KINGSLEY AVENUE, ORANGE PARK, FL, 320733003

Signature of
Role Plan administrator
Date 2022-06-15
Name of individual signing KIMBERLY DEAL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-06-15
Name of individual signing KIMBERLY DEAL
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2020 591275590 2021-06-11 ATKINSON'S MART, INC. 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 100 OLD ORANGE PARK RD., ORANGE PARK, FL, 320733003

Signature of
Role Plan administrator
Date 2021-06-11
Name of individual signing KIMBERLY DEAL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-06-11
Name of individual signing KIMBERLY DEAL
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2019 591275590 2020-06-18 ATKINSON'S MART, INC. 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 100 OLD ORANGE PARK RD., ORANGE PARK, FL, 320733003

Signature of
Role Plan administrator
Date 2020-06-18
Name of individual signing KIMBERLY DEAL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-06-18
Name of individual signing KIMBERLY DEAL
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2018 591275590 2019-05-23 ATKINSON'S MART, INC. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 100 OLD ORANGE PARK RD, ORANGE PARK, FL, 320733003

Signature of
Role Plan administrator
Date 2019-05-23
Name of individual signing ROBERT ALLEN
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2017 591275590 2018-05-31 ATKINSON'S MART, INC. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 100 OLD ORANGE PARK RD, ORANGE PARK, FL, 320733003

Signature of
Role Plan administrator
Date 2018-05-31
Name of individual signing ROBERT ALLEN
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2016 591275590 2017-04-25 ATKINSON'S MART, INC. 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 100 OLD ORANGE PARK ROAD, ORANGE PARK, FL, 32073

Signature of
Role Plan administrator
Date 2017-04-25
Name of individual signing ROBERT ALLEN
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2015 591275590 2016-08-02 ATKINSON'S MART, INC. 47
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 100 OLD ORANGE PARK ROAD, ORANGE PARK, FL, 32073

Signature of
Role Plan administrator
Date 2016-08-02
Name of individual signing ROBERT ALLEN
Valid signature Filed with authorized/valid electronic signature
ATKINSON'S MART, INC. PROFIT SHARING 401(K) PLAN 2014 591275590 2015-07-15 ATKINSON'S MART, INC. 49
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1993-01-01
Business code 446110
Sponsor’s telephone number 9042647578
Plan sponsor’s address 100 OLD ORANGE PARK ROAD, ORANGE PARK, FL, 32073

Signature of
Role Plan administrator
Date 2015-07-15
Name of individual signing ROBERT ALLEN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-15
Name of individual signing ROBERT ALLEN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Scott William A Agent 462 KINGSLEY AVENUE, ORANGE PARK, FL, 32073

Director

Name Role Address
ALLEN ROBERT EJr. Director 1994-A KINGSLEY AVE, ORANGE PARK, FL, 32073
DEAL KIMBERLY D Director 1994-A KINGSLEY AVE, ORANGE PARK, FL, 32073
DAVIS KELLY Director 1994-A KINGSLEY AVE., ORANGE PARK, FL, 32073

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G21000035802 ATKINSON'S HEALTHCARE ACTIVE 2021-03-15 2026-12-31 No data 1994-A KINGSLEY AVENUE, ORANGE PARK, FL, 32073
G21000035812 ATKINSON'S HEALTHCARE PROVIDERS ACTIVE 2021-03-15 2026-12-31 No data 1994-A KINGSLEY AVENUE, ORANGE PARK, FL, 32073
G21000017942 ATKINSON'S HOSPITAL PHARMACY ACTIVE 2021-02-05 2026-12-31 No data 1994-A KINGSLEY AVENUE, ORANGE PARK, FL, 32073
G15000012782 ATKINSON'S HOSPITAL PHARMACY EXPIRED 2015-02-05 2020-12-31 No data 1994-A KINGSLEY AVENUE, ORANGE PARK, FL, 32073

Events

Event Type Filed Date Value Description
AMENDMENT 2018-06-18 No data No data
MERGER 2003-12-24 No data CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 300000047403

Related by officers

Scott William A

WET PAINT, INC. ALLEN DAVIS VENTURES, INC. PARK MEDICAL CENTER, P.A. TOLSON-BYRNS PARTNERSHIP, LTD. ABUNDANT JOY CHRISTIAN FELLOWSHIP, INC. BYRNS-TOLSON ENTERPRISES, INC. GLEN A. BYRNS PARTNERSHIP, LTD.

DAVIS KELLY

ALLEN DAVIS VENTURES, INC. THE FIRST CHURCH OF GOD, ORLANDO, FLORIDA, INC. NEWTREK INC. CAPT. SCUBA, INC. THE EARLIEST YEARS, INC.

Related by address

No related companies by address

Date of last update: 02 Jan 2025

Sources: Florida Department of State

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