| Entity Name: | ST JOSEPH PHARMACY & MEDICAL SUPPLIES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Sep 2007 (17 years ago) |
| Document Number: | L07000093086 |
| FEI/EIN Number | 142006786 |
| Address: | 35780 SR 54, SUITE 101, ZEPHYRHILLS, FL, 33541, US |
| Mail Address: | 35780 SR 54, SUITE 101, ZEPHYRHILLS, FL, 33541 |
| ZIP code: | 33541 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326294919 | 2008-08-14 | 2017-02-20 | 35780 SR 54, SUITE 101, ZEPHYRHILLS, FL, 335412242, US | 35780 STATE ROAD 54 STE 101, ZEPHYRHILLS, FL, 335412242, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-782-4854 |
| Fax | 8137824856 |
Authorized person
| Name | MINIMOL KURIAKOSE |
| Role | PHARMACY MANAGER |
| Phone | 8137824854 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24247 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001689600 |
| State | FL |
| Issuer | PK |
| Number | 2122052 |
| Name | Role |
|---|---|
| ST. JOSEPH'S PHARMACY, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| KURIAKOSE MINIMOL | Manager | 35780 SR 54, ZEPHYRHILL, FL, 34652 |
| Name | Role | Address |
|---|---|---|
| KURIAKOSE MINIMOL | Auth | 35780 SR 54, ZEPHYRHILLS, FL, 33541 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-19 | 35780 SR 54, SUITE 101, ZEPHYRHILLS, FL 33541 | No data |
| CHANGE OF MAILING ADDRESS | 2010-03-30 | 35780 SR 54, SUITE 101, ZEPHYRHILLS, FL 33541 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-03-30 | ST. JOSEPH'S PHARMACY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-03-30 | 35780 SR 54, 101, ZEPHYRHILLS, FL 34652 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-21 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-06-19 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-03-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
