| Entity Name: | KRISHNA PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 06 Apr 2009 (16 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L09000032951 |
| FEI/EIN Number | 264639499 |
| Address: | 14102 PALM BEACH BLVD., FORT MYERS, FL, 33905, US |
| Mail Address: | 14102 PALM BEACH BLVD., FORT MYERS, FL, 33905, US |
| ZIP code: | 33905 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457686602 | 2009-10-06 | 2011-02-02 | 14102 PALM BEACH BLVD, FORT MYERS, FL, 339052244, US | 14102 PALM BEACH BLVD, FORT MYERS, FL, 339052244, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 239-362-2760 |
| Fax | 2393622761 |
Authorized person
| Name | JIGNESH PATEL |
| Role | MANAGER |
| Phone | 2393622760 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24294 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001554700 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1049786 |
| Name | Role | Address |
|---|---|---|
| PATEL SUSMITA P | Agent | 7408 SIKA DEER WAY, FORT MYERS, FL, 33966 |
| Name | Role | Address |
|---|---|---|
| PATEL JIGNESH A | Manager | 7408 SIKA DEER WAY, FORT MYERS, FL, 33966 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000125681 | RIVERDALE PHARMACY | EXPIRED | 2009-06-23 | 2014-12-31 | No data | 14102 PALM BEACH BLVD, FORT MYERS, FL, 33905 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| LC AMENDMENT | 2009-12-02 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2009-12-02 | PATEL, SUSMITA P | No data |
| LC AMENDMENT | 2009-07-29 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-07-29 | 14102 PALM BEACH BLVD., FORT MYERS, FL 33905 | No data |
| CHANGE OF MAILING ADDRESS | 2009-07-29 | 14102 PALM BEACH BLVD., FORT MYERS, FL 33905 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-01-14 |
| ANNUAL REPORT | 2011-01-10 |
| ANNUAL REPORT | 2010-01-20 |
| LC Amendment | 2009-12-02 |
| LC Amendment | 2009-07-29 |
| Florida Limited Liability | 2009-04-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
