| Entity Name: | HILLMOOR PLAZA PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Dec 1984 (40 years ago) |
| Document Number: | H36446 |
| FEI/EIN Number | 592473780 |
| Address: | 800 VIRGINIA AVE., SUITE 31, FORT PIERCE, FL, 34982, US |
| Mail Address: | 800 VIRGINIA AVE., SUITE 31, FORT PIERCE, FL, 34982, US |
| ZIP code: | 34982 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053356113 | 2006-06-20 | 2009-05-13 | 9312 FOREST HILL BLVD, WELLINGTON, FL, 334116577, US | 9312 FOREST HILL BLVD, WELLINGTON, FL, 334116577, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 561-753-6768 |
| Fax | 5617536763 |
Authorized person
| Name | VICTORIA WEIDEMAN |
| Role | CEO |
| Phone | 7724680074 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH13112 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336H0001X - Home Infusion Therapy Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102866900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 102866902 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1075022 |
| Issuer | MEDICAID |
| Number | 102866901 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WEIDEMAN VICTORIA A | Agent | 800 VIRGINIA AVE., FT. PIERCE, FL, 34982 |
| Name | Role | Address |
|---|---|---|
| WEIDEMAN VICTORIA A | President | 800 VIRGINIA AVE., FORT PIERCE, FL, 34982 |
| Name | Role | Address |
|---|---|---|
| WEIDEMAN VICTORIA A | Secretary | 800 VIRGINIA AVE., FORT PIERCE, FL, 34982 |
| Name | Role | Address |
|---|---|---|
| WEIDEMAN VICTORIA A | Director | 800 VIRGINIA AVE., FORT PIERCE, FL, 34982 |
| Name | Role | Address |
|---|---|---|
| WEIDEMAN JOHN R | Treasurer | 800 VIRGINIA AVE., FORT PIERCE, FL, 34982 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08315900434 | MY COMMUNITY PHARMACY | EXPIRED | 2008-11-10 | 2013-12-31 | No data | 9312 FOREST HILL BLVD, WELLINGTON, FL, 33411 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REINSTATEMENT | 2003-06-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2002-10-04 | No data | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
