| Entity Name: | DJ PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Aug 2009 (15 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | L09000080211 |
| FEI/EIN Number | 270768537 |
| Mail Address: | 20122 SHADY HILL LANE, TAMPA, FL, 33647, US |
| Address: | 5622 MARINE PARKWAY, SUITE #23, (OPPOSITE COMMUNITY HOSPITAL), NEW PORT RICHEY, FL, 34652, US |
| ZIP code: | 34652 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528399474 | 2010-01-15 | 2011-09-19 | 20122 SHADY HILL LN, TAMPA, FL, 336473396, US | 5622 MARINE PKWY STE 23, NEW PORT RICHEY, FL, 346524335, US | |||||||||||||||||||||||
|
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| Phone | +1 813-495-2234 |
| Phone | +1 727-232-0646 |
Authorized person
| Name | OMOTADE IKUDAYISI |
| Role | OWNER |
| Phone | 8134952234 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24393 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1052632 |
| Name | Role | Address |
|---|---|---|
| WALKER GARY | Agent | 202 S ROME AVENUE, TAMPA, FL, 33606 |
| Name | Role | Address |
|---|---|---|
| IKUDAYISI OMOTADE T | Managing Member | 20122 SHADY HILL LANE, TAMPA, FL, 33647 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000175529 | DJ PHARMACY | EXPIRED | 2009-11-15 | 2014-12-31 | No data | 20122 SHADY HILL LANE, TAMPA, FL, 33647 |
| G09000149398 | DJ PHARMACY | EXPIRED | 2009-08-25 | 2014-12-31 | No data | 20122 SHADY HILL LANE, TAMPA, FL, 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| LC AMENDMENT | 2011-04-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-28 | 5622 MARINE PARKWAY, SUITE #23, (OPPOSITE COMMUNITY HOSPITAL), NEW PORT RICHEY, FL 34652 | No data |
| LC AMENDMENT | 2011-04-18 | No data | No data |
| Name | Date |
|---|---|
| LC Amendment | 2011-04-28 |
| LC Amendment | 2011-04-18 |
| ANNUAL REPORT | 2011-03-15 |
| ANNUAL REPORT | 2010-01-11 |
| Florida Limited Liability | 2009-08-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
