| Entity Name: | HABANA HOSPITAL PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 23 Feb 1970 (55 years ago) |
| Date of dissolution: | 11 Oct 2016 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 11 Oct 2016 (8 years ago) |
| Document Number: | 360040 |
| FEI/EIN Number | 59-1296170 |
| Address: | 4710 N. HABANA AVE., SUITE 101, TAMPA, FL 33614 |
| Mail Address: | 4710 N. HABANA AVE., SUITE 101, TAMPA, FL 33614 |
| ZIP code: | 33614 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528167194 | 2006-09-21 | 2015-04-07 | 4710 N HABANA AVE, #101, TAMPA, FL, 336147161, US | 4710 N HABANA AVE, #101, TAMPA, FL, 336147161, US | |||||||||||||||||||||||||
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| Phone | +1 813-872-7771 |
| Fax | 8138728295 |
Authorized person
| Name | DR. TERRENCE CAMERON MYERS JR. |
| Role | PRESIDENT/PHARMACIST |
| Phone | 8138727771 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH1515 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101847700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Medendorp, Steven R | Agent | 4710 N. HABANA AVE., SUITE 101, TAMPA, FL 33614 |
| Name | Role | Address |
|---|---|---|
| Myers, Terrance | Director | 4710 N. HABANA AVE., SUITE 101 TAMPA, FL 33614 |
| Goodkin, Ryan | Director | 4710 N. HABANA AVE., SUITE 101 TAMPA, FL 33614 |
| Medendorp, Steven | Director | 4710 N Habana Ave, 101 TAMPA, FL 33614 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000030680 | HABANA HOSPITAL PHARMACY | EXPIRED | 2014-03-26 | 2019-12-31 | No data | 4710 N. HABANA AVENUE, SUITE 101, TAMPA, FL, 33614 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2016-10-11 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-03-27 | Medendorp, Steven R | No data |
| REINSTATEMENT | 1995-10-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1995-08-25 | No data | No data |
| REINSTATEMENT | 1994-12-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1994-08-26 | No data | No data |
| REINSTATEMENT | 1993-10-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1993-08-13 | No data | No data |
| REINSTATEMENT | 1991-10-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1991-10-11 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2016-10-11 |
| ANNUAL REPORT | 2016-03-25 |
| ANNUAL REPORT | 2015-02-23 |
| ANNUAL REPORT | 2014-03-27 |
| ANNUAL REPORT | 2013-02-22 |
| ANNUAL REPORT | 2012-01-09 |
| ANNUAL REPORT | 2011-02-18 |
| ANNUAL REPORT | 2011-01-13 |
| ANNUAL REPORT | 2010-05-18 |
| ANNUAL REPORT | 2010-04-21 |
Date of last update: 06 Feb 2025
Sources: Florida Department of State
