| Entity Name: | COMMCARE PHARMACY - MIA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
COMMCARE PHARMACY - MIA, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 19 Sep 2005 (20 years ago) |
| Date of dissolution: | 25 May 2017 (8 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 25 May 2017 (8 years ago) |
| Document Number: | L05000092307 |
| FEI/EIN Number |
203531603
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | 13034 Ballantyne Corporate Place, Charlotte, NC, 28277, US |
| Address: | 1801 CORAL WAY, SUITE 115, MIAMI, FL, 33145 |
| ZIP code: | 33145 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063423606 | 2006-08-10 | 2016-06-20 | 855 SW 78TH AVE, STE C100, PLANTATION, FL, 333243223, US | 1801 CORAL WAY, STE 115, MIAMI, FL, 331452790, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-568-6212 |
| Fax | 9545682765 |
| Phone | +1 305-854-5535 |
| Fax | 3058545929 |
Authorized person
| Name | RICHARD DOUGHERTY |
| Role | COO |
| Phone | 9543326170 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| License Number | PH21974 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031649100 |
| State | FL |
| Issuer | PK |
| Number | 2006806 |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 S. PINE ISLAND ROAD, PLANTATION, FL, 33324 |
| Castillo Susan | Vice President | 855 SW 78TH AVE,Suite C100, Plantation, FL, 33324 |
| Forrest Anna- Marie | Secretary | 13034 Ballantyne Corporate Place, Charlotte, NC, 28277 |
| Gilbert Durral | Director | 13036 Ballantyne Corporate Place, Charlotte, NC, 28277 |
| Isaak Greg | President | 856 SW 78TH AVE,Suite C100, Plantation, FL, 33324 |
| McKasson Craig | Manager | 13034 Ballantyne Corporate Place, Charlotte, NC, 28277 |
| Price Kelli | Manager | 13034 Ballantyne Corporate Pl., Charlotte, NC, 28277 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000014393 | COMMCARE SPECIALTY PHARMACY | EXPIRED | 2016-02-09 | 2021-12-31 | - | 855 SW 78 AVE., STE C100, PLANATION, FL, 33324 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2017-05-25 | - | - |
| CHANGE OF MAILING ADDRESS | 2017-04-06 | 1801 CORAL WAY, SUITE 115, MIAMI, FL 33145 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2011-04-06 | 1200 S. PINE ISLAND ROAD, PLANTATION, FL 33324 | - |
| REGISTERED AGENT NAME CHANGED | 2011-04-06 | CT CORPORATION SYSTEM | - |
| LC AMENDED AND RESTATED ARTICLES | 2009-03-27 | - | - |
| LC NAME CHANGE | 2006-10-27 | COMMCARE PHARMACY - MIA, LLC | - |
| CHANGE OF PRINCIPAL ADDRESS | 2006-04-19 | 1801 CORAL WAY, SUITE 115, MIAMI, FL 33145 | - |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2017-05-25 |
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-01-12 |
| ANNUAL REPORT | 2015-03-18 |
| ANNUAL REPORT | 2014-03-12 |
| ANNUAL REPORT | 2013-02-25 |
| ANNUAL REPORT | 2012-01-05 |
| ANNUAL REPORT | 2011-04-06 |
| ANNUAL REPORT | 2010-01-19 |
| LC Amended and Restated Art | 2009-03-27 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
