| Entity Name: | ST. MARY PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Jan 2009 (16 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 19 Oct 2010 (14 years ago) |
| Document Number: | L09000000417 |
| FEI/EIN Number | 263961195 |
| Address: | 1290 WEST BAY DR., LARGO, FL, 33770, US |
| Mail Address: | 1290 WEST BAY DR., LARGO, FL, 33770, US |
| ZIP code: | 33770 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740423573 | 2009-04-09 | 2017-02-16 | 1290 W BAY DR, LARGO, FL, 337702204, US | 1290 W BAY DR, LARGO, FL, 337702204, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-585-1333 |
| Fax | 7275851344 |
Authorized person
| Name | JOHN SHAKER |
| Role | PHARMACIST (PARTNER) |
| Phone | 7276378174 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH23976 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2119775 |
| Issuer | MEDICAID |
| Number | 001226300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHAKER ALBERT | Agent | 450 SOUTH GULF VIEW UNIT 1106, CLEAR WATER BEACH, FL, 33767 |
| Name | Role | Address |
|---|---|---|
| SHAKER ALBERT | Managing Member | 450 S GULF VIEW BLV UNIT 1106, CLEAR WATER BEACH, FL, 33767 |
| Name | Role | Address |
|---|---|---|
| shaker john | Manager | 450 south gulf view blv, clear water, FL, 33767 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2011-01-25 | 450 SOUTH GULF VIEW UNIT 1106, CLEAR WATER BEACH, FL 33767 | No data |
| LC AMENDMENT | 2010-10-19 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-03-02 | 1290 WEST BAY DR., LARGO, FL 33770 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-03-02 | SHAKER, ALBERT | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| ANNUAL REPORT | 2023-03-22 |
| ANNUAL REPORT | 2022-04-12 |
| ANNUAL REPORT | 2021-03-12 |
| ANNUAL REPORT | 2020-04-27 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-03-17 |
| ANNUAL REPORT | 2016-04-20 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
