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 |
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 | |||||||||||||||||||||||||||||||||
|
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 |
Name | Role | Address |
---|---|---|
SCHIFF, JAMES M. | Agent | 9100 SOUTH DADELAND BLVD., STE. #1010, MIAMI, FL, 33156 |
Name | Role | Address |
---|---|---|
SMITH, ORIN E. | Vice President | 4000 RED ROAD, MIAMI, FL, 33155 |
Name | Role | Address |
---|---|---|
COLLAZO, AURELIO J | President | 4000 RED ROAD, MIAMI, FL |
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 |
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