| Entity Name: | EL VIGNOBLE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Sep 2007 (17 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 20 May 2016 (9 years ago) |
| Document Number: | L07000096917 |
| FEI/EIN Number | 261133035 |
| Address: | 4904 Woodlands Blvd, Tamarac, FL, 33319, US |
| Mail Address: | 4904 Woodlands Blvd, Tamarac, FL, 33319, US |
| ZIP code: | 33319 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619125713 | 2008-09-03 | 2009-08-28 | 4850 WEST OAKLAND BLVD, SUITE 106 & 108, LAUDERDALE LAKES, FL, 33313, US | 4850 WEST OAKLAND BLVD, SUITE 106 & 108, LAUDERDALE LAKES, FL, 33313, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 954-530-4793 |
| Phone | +1 954-696-3641 |
Authorized person
| Name | SINIKIWE CHIWARA |
| Role | OWNER |
| Phone | 9545304793 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH23858 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000623300 |
| State | FL |
| Issuer | NCPDP |
| Number | 1039266 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHIWARA SINIKIWE | Agent | 4904 Woodlands Blvd, Tamarac, FL, 33319 |
| Name | Role | Address |
|---|---|---|
| CHIWARA SINIKIWE | Managing Member | 4904 Woodlands Blvd, Tamarac, FL, 33319 |
| Name | Role | Address |
|---|---|---|
| CHIWARA ANDREW M | Auth | 4904 WOODLANDS BLVD, TAMARAC, FL, 33319 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09054900411 | MEDIX PHARMACY | EXPIRED | 2009-02-22 | 2014-12-31 | No data | 4850 W OAKLAND PARK BLVD, STE 106, LAUDERDALE LAKES, FL, 33313 |
| G08322900184 | THE MEDICINE SHOPPE # 1936 | EXPIRED | 2008-11-17 | 2013-12-31 | No data | 4904 WOODLANDS BLVD, TAMARAC, FL, 33319 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2016-05-20 | 4904 Woodlands Blvd, Tamarac, FL 33319 | No data |
| REINSTATEMENT | 2016-05-20 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-05-20 | 4904 Woodlands Blvd, Tamarac, FL 33319 | No data |
| CHANGE OF MAILING ADDRESS | 2016-05-20 | 4904 Woodlands Blvd, Tamarac, FL 33319 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-05-20 | CHIWARA, SINIKIWE | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REINSTATEMENT | 2010-10-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| CANCEL ADM DISS/REV | 2009-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000558168 | TERMINATED | 1000000226771 | BROWARD | 2011-07-27 | 2031-08-31 | $ 382.62 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3111 N UNIVERSITY DR STE 501, CORAL SPRINGS FL330655096 |
| J11000490412 | TERMINATED | 1000000226772 | BROWARD | 2011-07-25 | 2021-08-03 | $ 501.25 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3111 N UNIVERSITY DR STE 501, CORAL SPRINGS FL330655096 |
| J10001132221 | TERMINATED | 1000000197102 | BROWARD | 2010-12-15 | 2030-12-22 | $ 672.75 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3111 N UNIVERSITY DR STE 501, CORAL SPRINGS FL330655096 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-03-03 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-08-30 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-08-17 |
| REINSTATEMENT | 2016-05-20 |
| ANNUAL REPORT | 2014-04-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
