| Entity Name: | COUNTRY VALUE PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 06 May 2010 (15 years ago) |
| Date of dissolution: | 07 Nov 2011 (13 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 07 Nov 2011 (13 years ago) |
| Document Number: | L10000049018 |
| FEI/EIN Number | 272511391 |
| Address: | 6201 N. FEDERAL HWY, BOCA RATON, FL, 33487, US |
| Mail Address: | 6201 N. FEDERAL HWY, BOCA RATON, FL, 33487, US |
| ZIP code: | 33487 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619285988 | 2010-09-20 | 2011-04-13 | 6201 N FEDERAL HWY, BOCA RATON, FL, 334873200, US | 6201 N FEDERAL HWY, BOCA RATON, FL, 334873200, US | |||||||||||||||||||||||||||
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| Phone | +1 561-995-0355 |
| Fax | 5619950435 |
Authorized person
| Name | AL LEFRANCOIS |
| Role | MANAGER |
| Phone | 5619950355 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24840 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5703245 |
| Name | Role | Address |
|---|---|---|
| EVANSEN DAVID | Agent | 6201 N. FEDERAL HWY, BOCA RATON, FL, 33487 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2011-11-07 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-30 | 6201 N. FEDERAL HWY, BOCA RATON, FL 33487 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-30 | 6201 N. FEDERAL HWY, BOCA RATON, FL 33487 | No data |
| LC AMENDMENT | 2010-05-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-05-24 | 6201 N. FEDERAL HWY, BOCA RATON, FL 33487 | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2011-11-07 |
| CORLCMMRES | 2011-09-20 |
| ANNUAL REPORT | 2011-04-30 |
| LC Amendment | 2010-05-24 |
| Florida Limited Liability | 2010-05-06 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
