| Entity Name: | MADABHUSHI PHARMACY SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 06 Aug 2007 (18 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L07000080953 |
| FEI/EIN Number | 260733061 |
| Address: | 14936 NORTH FLORIDA AVENUE, TAMPA, FL, 33613 |
| Mail Address: | 14936 NORTH FLORIDA AVENUE, TAMPA, FL, 33613 |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518153634 | 2007-09-21 | 2023-03-07 | 14936 N FLORIDA AVE, TAMPA, FL, 336131626, US | 14936 N FLORIDA AVE, TAMPA, FL, 336131626, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 813-961-6546 |
| Fax | 8139636379 |
Authorized person
| Name | SABRINA MADABHUSHI |
| Role | PHARMACIST-IN-CHARGE |
| Phone | 8139616546 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PS35846 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NCPDP # |
| Number | 1028845 |
| State | FL |
| Issuer | MEDICAID |
| Number | 0323349 00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MADABHUSHI PRAHLAD | Agent | 1651 Virginia Willow Dr, Wesley Chapel, FL, 33544 |
| Name | Role | Address |
|---|---|---|
| MADABHUSHI PRAHLAD | Manager | 1651 Virginia Willow Dr, Wesley Chapel, FL, 33544 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000065128 | MEDICINE PLACE | EXPIRED | 2015-06-23 | 2020-12-31 | No data | 14936 NORTH FLORIDA AVE, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-02-11 | 1651 Virginia Willow Dr, Wesley Chapel, FL 33544 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-06-12 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-02-11 |
| ANNUAL REPORT | 2016-03-27 |
| ANNUAL REPORT | 2015-01-13 |
| ANNUAL REPORT | 2014-01-08 |
| ANNUAL REPORT | 2013-01-29 |
| ANNUAL REPORT | 2012-01-04 |
| ANNUAL REPORT | 2011-02-27 |
| ANNUAL REPORT | 2010-02-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
