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MY PHARMACY OF BIRD ROAD, INC.

Company Details

Entity Name: MY PHARMACY OF BIRD ROAD, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 14 Jul 1986 (39 years ago)
Document Number: J23871
FEI/EIN Number 592701886
Address: 4000 RED ROAD, MIAMI, FL, 33155
Mail Address: 806 N.Krome, Homestead, FL, 33030, US
ZIP code: 33155
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1245316272 2006-10-31 2014-12-11 4000 SW 57TH AVE, MIAMI, FL, 331555318, US 4000 SW 57TH AVE, MIAMI, FL, 331555318, US

Contacts

Phone +1 305-666-8582
Fax 3056669110

Authorized person

Name MR. AURELIO J. COLLAZO
Role PRESIDENT
Phone 3056668582

Taxonomy

Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
License Number PH28703
State FL
Is Primary Yes
Taxonomy Code 333600000X - Pharmacy
License Number PH28703
State FL
Is Primary No

Other Provider Identifiers

Issuer MEDICAID
Number 109383501
State FL

Agent

Name Role Address
SCHIFF, JAMES M. Agent 9100 SOUTH DADELAND BLVD., STE. #1010, MIAMI, FL, 33156

Vice President

Name Role Address
SMITH, ORIN E. Vice President 4000 RED ROAD, MIAMI, FL, 33155

President

Name Role Address
COLLAZO, AURELIO J President 4000 RED ROAD, MIAMI, FL

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G10000028900 ALLENS DRUGS EXPIRED 2010-03-29 2015-12-31 No data 4000 RED ROAD, MIAMI, FL, 33155

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2020-09-25 No data No data

Date of last update: 01 Jan 2025

Sources: Florida Department of State