| Entity Name: | SEASIDE FAMILY PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 23 Jan 2006 (19 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | L06000007984 |
| FEI/EIN Number | 030579462 |
| Address: | c/o Island Family Pharmacy, 600 Plantation Island Dr. S., ST. AUGUSTINE, FL, 32080, US |
| Mail Address: | c/o Island Family Pharmacy, 600 Plantation Island Dr. S., ST. AUGUSTINE, FL, 32080, US |
| ZIP code: | 32080 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245283423 | 2006-05-18 | 2012-02-06 | 4075 A1A S, STE 102, ST AUGUSTINE, FL, 320806773, US | 4075 A1A S, STE 102, ST AUGUSTINE, FL, 320806773, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 904-461-3299 |
| Fax | 9044613277 |
Authorized person
| Name | JAMES PENNINGTON |
| Role | CO OWNER |
| Phone | 9044613299 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH21889 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031351200 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1018301 |
| Name | Role | Address |
|---|---|---|
| PENNINGTON JAMES D | Agent | 115 SAN RAFAEL RD., ST. AUGUSTINE, FL, 32080 |
| Name | Role | Address |
|---|---|---|
| PENNINGTON JAMES DENNIS | Manager | 4075 A1A SOUTH, SUITE 102, ST. AUGUSTINE, FL, 32080 |
| BLANCO RYAN | Manager | 3485 KINGS RD. S., ST AUGUSTINE, FL, 32086 |
| MCCARTY ANTHONY O | Manager | 4112 CREEK BLUFF DR, ST AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-02-09 | c/o Island Family Pharmacy, 600 Plantation Island Dr. S., Unit 3, ST. AUGUSTINE, FL 32080 | No data |
| CHANGE OF MAILING ADDRESS | 2013-02-09 | c/o Island Family Pharmacy, 600 Plantation Island Dr. S., Unit 3, ST. AUGUSTINE, FL 32080 | No data |
| REGISTERED AGENT NAME CHANGED | 2008-04-09 | PENNINGTON, JAMES DMANAGER | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-04-09 | 115 SAN RAFAEL RD., ST. AUGUSTINE, FL 32080 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-02-09 |
| ANNUAL REPORT | 2012-03-11 |
| ANNUAL REPORT | 2011-03-06 |
| ANNUAL REPORT | 2010-02-16 |
| ANNUAL REPORT | 2009-02-18 |
| ANNUAL REPORT | 2008-04-09 |
| ANNUAL REPORT | 2007-01-05 |
| Florida Limited Liability | 2006-01-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
