| Entity Name: | MALECON PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 25 Oct 1974 (50 years ago) |
| Document Number: | 462142 |
| FEI/EIN Number | 591566485 |
| Address: | 5966 W. 16TH AVENUE, HIALEAH, FL, 33012 |
| Mail Address: | 5966 W. 16TH AVENUE, HIALEAH, FL, 33012 |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811034119 | 2007-01-30 | 2016-04-07 | 5966 W 16TH AVE, HIALEAH, FL, 330126814, US | 5966 W 16TH AVE, HIALEAH, FL, 330126814, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-558-8551 |
| Fax | 3055588512 |
Authorized person
| Name | ANDREY SOLOVYEV |
| Role | PRESIDENT |
| Phone | 3055588551 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH6079 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336M0003X - Managed Care Organization Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003039900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 103293300 |
| State | FL |
| Issuer | MEDICAID |
| Number | 103293301 |
| State | FL |
| Issuer | PK |
| Number | 2004325 |
| Name | Role | Address |
|---|---|---|
| SOLOVIEV ANDREY | Agent | 5966 W. 16TH AVE, HLH, FL, 33012 |
| Name | Role | Address |
|---|---|---|
| SOLOVIEV ANDREY | Chief Executive Officer | 5966 W 16TH AVE, HIALEAH, FL, 33162 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000021652 | OMNI HEALTH | EXPIRED | 2017-02-28 | 2022-12-31 | No data | 5966 W 16TH AVE, HIALEAH, FL, 33012 |
| G16000137869 | ONSHORE DUTY FREE | EXPIRED | 2016-12-22 | 2021-12-31 | No data | 5966 W 16TH AVE, HIALEAH, FL, 33140 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REINSTATEMENT | 2019-12-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REINSTATEMENT | 2017-10-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| AMENDMENT | 2008-12-05 | No data | No data |
| AMENDMENT | 2008-11-05 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
