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  5. INDIAN RIVER PHARMACY, INC.

INDIAN RIVER PHARMACY, INC.

Company Details

Entity Name: INDIAN RIVER PHARMACY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 01 Feb 1980 (45 years ago)
Document Number: 654664
FEI/EIN Number 591985593
Address: 3721 TENTH COURT, VERO BEACH, FL, 32960, US
Mail Address: 3721 TENTH COURT, VERO BEACH, FL, 32960, US
ZIP code: 32960
County: Indian River
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1528274222 2007-05-16 2020-08-22 3719 10TH CT, VERO BEACH, FL, 329606559, US 3719 10TH CT, VERO BEACH, FL, 329606559, US

Contacts
Phone +1 772-567-2557
Fax 7725670013

Authorized person
Name GREGORY MICHEAEL DECRESCENZO
Role PRESIDENT
Phone 7725672557

Taxonomy
Taxonomy Code 3336H0001X - Home Infusion Therapy Pharmacy
License Number PH19077
State FL
Is Primary Yes

Other Provider Identifiers
Issuer NCPDP
Number 1001154
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
INDIAN RIVER PHARMACY, INC 401K PROFIT SHARING PLAN 2016 591985593 2017-05-28 INDIAN RIVER PHARMACY, INC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 446110
Sponsor’s telephone number 7725672555
Plan sponsor’s address 3721 TENTH COURT, VERO BEACH, FL, 32960

Signature of
Role Plan administrator
Date 2017-05-28
Name of individual signing MARY DECRESCENZO
Valid signature Filed with authorized/valid electronic signature
INDIAN RIVER PHARMACY, INC 401K PROFIT SHARING PLAN 2015 591985593 2016-05-27 INDIAN RIVER PHARMACY, INC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 446110
Sponsor’s telephone number 7725672555
Plan sponsor’s address 3721 TENTH COURT, VERO BEACH, FL, 32960

Signature of
Role Plan administrator
Date 2016-05-27
Name of individual signing MARY DECRESCENZO
Valid signature Filed with authorized/valid electronic signature
INDIAN RIVER PHARMACY, INC 401K PROFIT SHARING PLAN 2014 591985593 2015-07-20 INDIAN RIVER PHARMACY, INC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 446110
Sponsor’s telephone number 7725672555
Plan sponsor’s address 3721 TENTH COURT, VERO BEACH, FL, 32960

Signature of
Role Plan administrator
Date 2015-07-20
Name of individual signing MARY DECRESCENZO
Valid signature Filed with authorized/valid electronic signature
INDIAN RIVER PHARMACY, INC 401K PROFIT SHARING PLAN 2013 591985593 2014-06-27 INDIAN RIVER PHARMACY, INC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 446110
Sponsor’s telephone number 7725672555
Plan sponsor’s address 3721 TENTH COURT, VERO BEACH, FL, 32960

Signature of
Role Plan administrator
Date 2014-06-27
Name of individual signing MARY DECRESCENZO
Valid signature Filed with authorized/valid electronic signature
INDIAN RIVER PHARMACY, INC 401K PROFIT SHARING PLAN 2012 591985593 2013-06-13 INDIAN RIVER PHARMACY, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 446110
Sponsor’s telephone number 7725672555
Plan sponsor’s address 3721 TENTH COURT, VERO BEACH, FL, 32960

Signature of
Role Plan administrator
Date 2013-06-12
Name of individual signing MARY DECRESCENZO
Valid signature Filed with authorized/valid electronic signature
INDIAN RIVER PHARMACY, INC 401K PROFIT SHARING PLAN 2011 591985593 2012-06-13 INDIAN RIVER PHARMACY, INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 446110
Sponsor’s telephone number 7725672555
Plan sponsor’s address 3721 TENTH COURT, VERO BEACH, FL, 32960

Plan administrator’s name and address
Administrator’s EIN 591985593
Plan administrator’s name INDIAN RIVER PHARMACY, INC
Plan administrator’s address 3721 TENTH COURT, VERO BEACH, FL, 32960
Administrator’s telephone number 7725672555

Signature of
Role Plan administrator
Date 2012-06-13
Name of individual signing MARY DECRESCENZO
Valid signature Filed with authorized/valid electronic signature
INDIAN RIVER PHARMACY, INC 401K PROFIT SHARING PLAN 2010 591985593 2011-06-20 INDIAN RIVER PHARMACY, INC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-07-01
Business code 446110
Sponsor’s telephone number 7725672555
Plan sponsor’s address 3721 TENTH COURT, VERO BEACH, FL, 32960

Plan administrator’s name and address
Administrator’s EIN 591985593
Plan administrator’s name INDIAN RIVER PHARMACY, INC
Plan administrator’s address 3721 TENTH COURT, VERO BEACH, FL, 32960
Administrator’s telephone number 7725672555

Signature of
Role Plan administrator
Date 2011-06-20
Name of individual signing MARY DECRESCENZO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DECRESCENZO GREGORY Agent 3721 10TH CT, VERO BEACH, FL, 32960

President

Name Role Address
DECRESCENZO GREGORY President 3721 10TH COURT, VERO BEACH, FL, 32960

Director

Name Role Address
DECRESCENZO GREGORY Director 3721 10TH COURT, VERO BEACH, FL, 32960
DECRESCENZO MARY Director 3721 10TH COURT, VERO BEACH, FL, 32960

Secretary

Name Role Address
DECRESCENZO MARY Secretary 3721 10TH COURT, VERO BEACH, FL, 32960

Treasurer

Name Role Address
DECRESCENZO MARY Treasurer 3721 10TH COURT, VERO BEACH, FL, 32960

Vice President

Name Role Address
LAZARUS KATHERINE T Vice President 2338 OCEANWALK DR., ATLANTIC BEACH, FL, 32233
MOORE LISA R Vice President 225 39TH COURT, VERO BEACH, FL, 32978

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G96340000077 PERKINS INDIAN RIVER PHARMACY ACTIVE 1996-12-05 2026-12-31 No data 3721 10TH COURT, VERO BEACH, FL, 32960

Events

Event Type Filed Date Value Description
REINSTATEMENT 1987-12-16 No data No data
INVOLUNTARILY DISSOLVED 1987-11-16 No data No data

Related by officers

DECRESCENZO MARY

OCTAGON ASSOCIATES, INC.

MOORE LISA R

LADY DOWDY #150, INC THE WORLDWIDE VIRTUAL COMMUNITY OF THE DISABLED, INC.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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