| Entity Name: | LAGE PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Feb 1984 (41 years ago) |
| Document Number: | G98549 |
| FEI/EIN Number | 592422575 |
| Address: | 3485 WEST FLAGLER STREET, SUITE 200, MIAMI, FL, 33135 |
| Mail Address: | 3485 WEST FLAGLER STREET, SUITE 200, MIAMI, FL, 33135 |
| ZIP code: | 33135 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770665564 | 2006-10-20 | 2011-03-29 | 3485 W FLAGLER ST STE 200, MIAMI, FL, 331351042, US | 3485 W FLAGLER ST STE 200, MIAMI, FL, 331351042, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-649-3333 |
| Fax | 3056495722 |
Authorized person
| Name | MARIA MUSTAFA |
| Role | PRESIDENT |
| Phone | 3056493333 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH8887 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025545900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 025545901 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1037022 |
| Name | Role | Address |
|---|---|---|
| MUSTAFA MARIA E | Agent | 3485 W. FLAGLER ST., MIAMI, FL, 33135 |
| Name | Role | Address |
|---|---|---|
| MUSTAFA MARIA E | President | 3485 W. FLAGLER ST. SUITE 200, MIAMI, FL, 33135 |
| Name | Role | Address |
|---|---|---|
| MUSTAFA MARIA E | Vice President | 3485 W. FLAGLER ST. SUITE 200, MIAMI, FL, 33135 |
| Name | Role | Address |
|---|---|---|
| MUSTAFA MARIA E | Secretary | 3485 W. FLAGLER ST. SUITE 200, MIAMI, FL, 33135 |
| Name | Role | Address |
|---|---|---|
| MUSTAFA MARIA E | Treasurer | 3485 W. FLAGLER ST. SUITE 200, MIAMI, FL, 33135 |
| Name | Role | Address |
|---|---|---|
| MUSTAFA MARIA E | Director | 3485 W. FLAGER ST., SUITE 200, MIAMI, FL, 33135 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| AMENDMENT | 2002-07-01 | No data | No data |
| AMENDMENT | 2002-02-01 | No data | No data |
| AMENDMENT | 2001-08-13 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J07000341803 | LAPSED | 07-21351-CA-32 | MIAMI-DADE COUNTY CIRCUIT CT | 2007-09-25 | 2012-10-19 | $23,920.94 | MCKESSON AUTOMATION SYSTEMS, INC., C/O GLENETTE BABB - 1 POST STREET, 33RD FLOOR, SAN FRANCISCO, CA 94104 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
