| Entity Name: | COMMCARE PHARMACY - MIA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Sep 2005 (19 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 |
| 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 |
| Name | Role | Address |
|---|---|---|
| Castillo Susan | Vice President | 855 SW 78TH AVE,Suite C100, Plantation, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| Forrest Anna- Marie | Secretary | 13034 Ballantyne Corporate Place, Charlotte, NC, 28277 |
| Name | Role | Address |
|---|---|---|
| Gilbert Durral | Director | 13036 Ballantyne Corporate Place, Charlotte, NC, 28277 |
| Name | Role | Address |
|---|---|---|
| Isaak Greg | President | 856 SW 78TH AVE,Suite C100, Plantation, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| 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 | No data | 855 SW 78 AVE., STE C100, PLANATION, FL, 33324 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2017-05-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2017-04-06 | 1801 CORAL WAY, SUITE 115, MIAMI, FL 33145 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-04-06 | 1200 S. PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-04-06 | CT CORPORATION SYSTEM | No data |
| LC AMENDED AND RESTATED ARTICLES | 2009-03-27 | No data | No data |
| LC NAME CHANGE | 2006-10-27 | COMMCARE PHARMACY - MIA, LLC | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-04-19 | 1801 CORAL WAY, SUITE 115, MIAMI, FL 33145 | No data |
| 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 Feb 2025
Sources: Florida Department of State
