| Entity Name: | BLUE SKY DISCOUNT PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 23 Jul 2010 (15 years ago) |
| Date of dissolution: | 30 Mar 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 30 Mar 2017 (8 years ago) |
| Document Number: | L10000077766 |
| FEI/EIN Number | 272893005 |
| Address: | 115 HICKORY ST, SUITE 101, WEST MELBOURNE, FL, 32904, UN |
| Mail Address: | 115 HICKORY ST, SUITE 101, WEST MELBOURNE, FL, 32904, UN |
| ZIP code: | 32904 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508168576 | 2010-11-24 | 2015-03-03 | 115 HICKORY ST, SUITE #101, WEST MELBOURNE, FL, 329043505, US | 115 HICKORY ST, SUITE #101, WEST MELBOURNE, FL, 329043505, US | |||||||||||||||||||||||||
|
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| Phone | +1 321-914-0823 |
| Fax | 3219140824 |
Authorized person
| Name | DEADRA THORNTON-WRIGHT |
| Role | OWNER |
| Phone | 3219140823 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH24968 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003753900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VELAZCO VICTOR | Agent | 115 Hickory St, West Melbourne, FL, 32904 |
| Name | Role |
|---|---|
| BLUE SKY DISCOUNT PHARMACY HOLDING LLC | Manager |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-03-30 | No data | No data |
| LC AMENDMENT | 2016-07-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-07-25 | VELAZCO, VICTOR | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-03-11 | 115 Hickory St, Suite 101, West Melbourne, FL 32904 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-10 | 115 HICKORY ST, SUITE 101, WEST MELBOURNE, FL 32904 UN | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-10 | 115 HICKORY ST, SUITE 101, WEST MELBOURNE, FL 32904 UN | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-27 |
| LC Amendment | 2016-07-25 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-02-26 |
| ANNUAL REPORT | 2014-03-11 |
| ANNUAL REPORT | 2013-01-24 |
| ANNUAL REPORT | 2012-04-10 |
| ANNUAL REPORT | 2011-04-03 |
| Florida Limited Liability | 2010-07-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
