| Entity Name: | KENNETH D. WURSTER DRUGS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 May 1978 (47 years ago) |
| Document Number: | 571307 |
| FEI/EIN Number | 591832221 |
| Address: | 3206 S WEST SHORE BLVD, TAMPA, FL, 33629, US |
| Mail Address: | 3206 S WEST SHORE BLVD, TAMPA, FL, 33629, US |
| ZIP code: | 33629 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467520262 | 2006-12-01 | 2017-02-20 | 3206 S WEST SHORE BLVD, TAMPA, FL, 336297652, US | 3206 S WEST SHORE BLVD, TAMPA, FL, 336297652, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-837-9095 |
| Fax | 8138390802 |
Authorized person
| Name | MAYRA WURSTER |
| Role | PRES |
| Phone | 8138379095 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH10939 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2007853 |
| Issuer | MEDICAID |
| Number | 10102980C |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WURSTER KEVIN K | Agent | 3206 S. WEST SHORE BLVD., TAMPA, FL, 33629 |
| Name | Role | Address |
|---|---|---|
| WURSTER, MAYRA | President | 1731 CYPRESS AVE., BELLEAIR, FL, 33756 |
| Name | Role | Address |
|---|---|---|
| WURSTER, MAYRA | Director | 1731 CYPRESS AVE., BELLEAIR, FL, 33756 |
| Name | Role | Address |
|---|---|---|
| AMANDA WURSTER | Vice President | 905 SEVARD AVE, CLEARWATER, FL, 33764 |
| Name | Role | Address |
|---|---|---|
| KEVIN WURSTER | Chief Financial Officer | 2478 13TH AVE. S.W., LARGO, FL, 33770 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000049306 | WEST SHORE PHARMACY | EXPIRED | 2013-05-24 | 2018-12-31 | No data | 3206 S. WEST SHORE BLVD., TAMPA, FL, 33629 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 1995-10-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1995-08-25 | No data | No data |
| REINSTATEMENT | 1989-10-31 | No data | No data |
| INVOLUNTARILY DISSOLVED | 1986-11-14 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
