| Entity Name: | PRIME PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 08 Feb 2010 (15 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L10000014551 |
| FEI/EIN Number | 271854334 |
| Address: | 7685 103RD ST, SUITE 4, JACKSONVILLE, FL, 32210, US |
| Mail Address: | 7685 103RD ST, SUITE 4, JACKSONVILLE, FL, 32210, US |
| ZIP code: | 32210 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962728360 | 2010-04-12 | 2019-01-10 | 7685 103RD ST STE 4, JACKSONVILLE, FL, 322109325, US | 7685 103RD ST STE 4, JACKSONVILLE, FL, 32210, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-813-7634 |
| Fax | 9045516555 |
Authorized person
| Name | SHERAZ MIRZA |
| Role | COO |
| Phone | 9045516555 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24868 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2126711 |
| Issuer | MEDICAID |
| Number | 002961800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| mirza khalid m | Agent | 7685 103RD ST, JACKSONVILLE, FL, 32210 |
| Name | Role | Address |
|---|---|---|
| mirza khalid m | Managing Member | 3604 university blvd, JACKSONVILLE, FL, 32216 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000101525 | PRIME PHARMACY | EXPIRED | 2017-09-06 | 2022-12-31 | No data | 3604 UNIVERSITY BLVD S, SUITE 102, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-07-29 | 7685 103RD ST, SUITE 4, JACKSONVILLE, FL 32210 | No data |
| CHANGE OF MAILING ADDRESS | 2021-07-29 | 7685 103RD ST, SUITE 4, JACKSONVILLE, FL 32210 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-07-29 | 7685 103RD ST, SUITE 4, JACKSONVILLE, FL 32210 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-03-02 | mirza, khalid m | No data |
| LC AMENDMENT | 2016-12-07 | No data | No data |
| LC AMENDMENT | 2016-05-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-05-02 |
| ANNUAL REPORT | 2021-07-29 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-03-02 |
| LC Amendment | 2016-12-07 |
| LC Amendment | 2016-05-25 |
| ANNUAL REPORT | 2016-05-02 |
| ANNUAL REPORT | 2015-04-27 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4542437705 | 2020-05-01 | 0491 | PPP | 7685 103RD STREET SUITE 4, JACKSONVILLE, FL, 32210 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Feb 2025
Sources: Florida Department of State
