| Entity Name: | PINE BROOK PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Mar 2009 (16 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 09 Nov 2020 (4 years ago) |
| Document Number: | L09000029511 |
| FEI/EIN Number | 264546906 |
| Address: | 19107 HARBOR COVE COURT, LUTZ, FL, 33558, US |
| Mail Address: | 19107 HARBOR COVE COURT, LUTZ, FL, 33558, US |
| ZIP code: | 33558 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588310239 | 2022-02-22 | 2022-02-22 | 14111 CORTEZ BLVD, BROOKSVILLE, FL, 346132707, US | 14111 CORTEZ BLVD, BROOKSVILLE, FL, 346132707, US | |||||||||||||||||||||
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| Phone | +1 352-610-4347 |
| Fax | 3526104349 |
Authorized person
| Name | DOROTHY SCHMECKPEPER |
| Role | PHARMACY SUPERVISOR |
| Phone | 3526104347 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001168201 |
| State | FL |
| Name | Role |
|---|---|
| MASSEY LAW GROUP, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| THAKKAR HEENA | Secretary | 19107 HARBOR COVE COURT, LUTZ, FL, 33558 |
| Name | Role |
|---|---|
| RAGSHIP LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000109497 | PINE BROOK PHARMACY | ACTIVE | 2021-08-24 | 2026-12-31 | No data | 19107 HARBOR COVE CT, LUTZ, FL, LUTZ, FL, 33558 |
| G18000055581 | PINE BROOK PHARMACY #4 | EXPIRED | 2018-05-04 | 2023-12-31 | No data | 19107 H, LUTZ, FL, 33558 |
| G13000042206 | PINE BROK PHARMA | EXPIRED | 2013-05-02 | 2018-12-31 | No data | 14482 CORTEZ BLVD, BROOKSVILLE, FL, 34613 |
| G09000117648 | PINE BROOK PHARMACY | EXPIRED | 2009-06-09 | 2014-12-31 | No data | 14482 CORTEZ BLVD, BROOKSVILLE, FL, 34613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2020-11-09 | No data | No data |
| LC STMNT OF RA/RO CHG | 2020-08-21 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-08-21 | MASSEY LAW GROUP, P.A. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-08-21 | 76 4TH STREET, 262, ST PETERSBURG, FL 33731 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-18 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-06 |
| LC Amendment | 2020-11-09 |
| CORLCRACHG | 2020-08-21 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-04 |
| ANNUAL REPORT | 2018-02-19 |
| ANNUAL REPORT | 2017-01-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
