| Entity Name: | ASHWINI HEALTHCARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 09 Nov 2009 (15 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | L09000107899 |
| FEI/EIN Number | 27-1270450 |
| Address: | 816 AUTUMN GLEN DRIVE, MELBOURNE, FL 32940 |
| Mail Address: | 816 AUTUMN GLEN DRIVE, MELBOURNE, FL 32940 |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295051845 | 2010-04-07 | 2011-10-25 | 816 AUTUMN GLEN DR, MELBOURNE, FL, 329406423, US | 401 N WICKHAM RD, SUITE W AND X, MELBOURNE, FL, 329358659, US | |||||||||||||||||||||||||||||||
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| Phone | +1 321-752-9125 |
| Phone | +1 321-751-7885 |
| Fax | 3217517886 |
Authorized person
| Name | MANASA THIMMEGOWDA |
| Role | MGRM |
| Phone | 3217529125 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24577 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002560400 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1055703 |
| Name | Role | Address |
|---|---|---|
| TAYLOR, SUSAN L | Agent | 3716 N. WICKHAM RD, 1, MELBOURNE, FL 32940 |
| Name | Role | Address |
|---|---|---|
| THIMMEGOWDA, MANASA | Managing Member | 816 AUTUMN GLEN DRIVE, MELBOURNE, FL 32940 |
| SRIKANTAIAH, SHIVAKUMAR | Managing Member | 816 AUTUMN GLEN DRIVE, MELBOURNE, FL 32940 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000184452 | MELBOURNE DISCOUNT PHARMACY | EXPIRED | 2009-12-14 | 2014-12-31 | No data | 816 AUTUMN GLEN DR, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-03-30 | 816 AUTUMN GLEN DRIVE, MELBOURNE, FL 32940 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-03-27 |
| ANNUAL REPORT | 2012-03-30 |
| ANNUAL REPORT | 2011-04-26 |
| ANNUAL REPORT | 2010-02-05 |
| Florida Limited Liability | 2009-11-09 |
Date of last update: 25 Jan 2025
Sources: Florida Department of State
