| Entity Name: | SUPERIOR PHARMACY OF TEMPLE TERRACE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Sep 2007 (17 years ago) |
| Last Event: | LC DISSOCIATION MEM |
| Event Date Filed: | 04 Apr 2017 (8 years ago) |
| Document Number: | L07000091079 |
| FEI/EIN Number | 47-1239943 |
| Address: | 9780 N 56th ST, Suite D, TEMPLE TERRACE, FL, 33617, US |
| Mail Address: | 9780 N 56th St, SUITE D, TEMPLE TERRACE, FL, 33617, US |
| ZIP code: | 33617 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265198709 | 2021-11-09 | 2021-11-09 | 9780 N 56TH ST STE D, TEMPLE TERRACE, FL, 336175508, US | 9780 N 56TH ST STE D, TEMPLE TERRACE, FL, 336175508, US | |||||||||||||||||||||
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| Phone | +1 813-989-1351 |
| Fax | 8139884795 |
Authorized person
| Name | YVONNE OKEKE |
| Role | PHARMACY MANAGER |
| Phone | 8139891351 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021697100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Okeke Yvonne | Agent | 9780 N 56TH ST, TEMPLE TERRACE, FL, 33617 |
| Name | Role | Address |
|---|---|---|
| Yvonne Okeke | President | 9780 N 56th ST, TEMPLE TERRACE, FL, 33617 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000143651 | TEMPLE TERRACE PHARMACY LTC | ACTIVE | 2021-10-25 | 2026-12-31 | No data | 9780 NORTH 56TH ST., SUITE D, TEMPLE TERRACE, FL, 33617 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-03 | 9780 N 56th ST, Suite D, TEMPLE TERRACE, FL 33617 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-03 | 9780 N 56th ST, Suite D, TEMPLE TERRACE, FL 33617 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-03-03 | Okeke, Yvonne | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-03 | 9780 N 56TH ST, Suite D, TEMPLE TERRACE, FL 33617 | No data |
| LC DISSOCIATION MEM | 2017-04-04 | No data | No data |
| LC AMENDMENT | 2013-10-21 | No data | No data |
| LC AMENDMENT | 2013-07-10 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-22 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-02-27 |
| ANNUAL REPORT | 2018-01-16 |
| CORLCDSMEM | 2017-04-04 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
