| Entity Name: | AMICITIA PHARMA, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Jun 2010 (15 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 24 Apr 2023 (2 years ago) |
| Document Number: | L10000065083 |
| FEI/EIN Number | 275279266 |
| Address: | 4105 49TH ST N,, ST PETERSBURG, FL, 33709, US |
| Mail Address: | 4105 49TH ST N,, ST PETERSBURG, FL, 33709, US |
| ZIP code: | 33709 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386102424 | 2019-03-07 | 2019-03-07 | 4105 49TH ST N STE B, SAINT PETERSBURG, FL, 337095711, US | 4105 49TH ST N STE B, SAINT PETERSBURG, FL, 337095711, US | |||||||||||||||||||||
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| Phone | +1 727-954-8877 |
| Fax | 7273298872 |
Authorized person
| Name | SOKHA YIM |
| Role | PHARMACY MANAGER |
| Phone | 7279548877 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003884500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AYOUB LENA E | Agent | 19535 Gulf Blvd, Indian Shores, FL, 33785 |
| Name | Role | Address |
|---|---|---|
| YIM SOKHA | Managing Member | 4105 49TH ST N, ST PETERSBURG, FL, 33709 |
| Name | Role | Address |
|---|---|---|
| YIM KRISTEN | Authorized Member | 4105 49TH ST N,, ST PETERSBURG, FL, 33709 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000045301 | 1ST CHOICE PHARMACY LTC | ACTIVE | 2022-04-10 | 2027-12-31 | No data | 4105 49TH ST N, STE B, ST PETERSBURG, FL, 33709 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2023-04-24 | No data | No data |
| LC AMENDMENT | 2022-05-10 | No data | No data |
| LC AMENDMENT | 2022-02-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-22 | 4105 49TH ST N,, STE B, ST PETERSBURG, FL 33709 | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-22 | 4105 49TH ST N,, STE B, ST PETERSBURG, FL 33709 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-18 | 19535 Gulf Blvd, SUITE E, Indian Shores, FL 33785 | No data |
| LC AMENDMENT | 2014-08-08 | No data | No data |
| LC AMENDMENT | 2011-03-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-17 |
| ANNUAL REPORT | 2024-01-05 |
| LC Amendment | 2023-04-24 |
| ANNUAL REPORT | 2023-01-05 |
| LC Amendment | 2022-05-10 |
| LC Amendment | 2022-02-28 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-05 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-02-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
