| Entity Name: | PRIME SYNERGY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 05 Oct 2010 (14 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | L10000104211 |
| FEI/EIN Number | 273603839 |
| Address: | 7333 LAKE UNDERHILL RD, ORLANDO, FL, 32822 |
| Mail Address: | 7333 LAKE UNDERHILL RD, ORLANDO, FL, 32822 |
| ZIP code: | 32822 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609186899 | 2010-10-21 | 2012-05-22 | 7333 LAKE UNDERHILL RD, ORLANDO, FL, 328226061, US | 7333 LAKE UNDERHILL RD, ORLANDO, FL, 328226061, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-704-6626 |
| Fax | 4077046627 |
Authorized person
| Name | RAMESH PATHAK |
| Role | PHARMACY MANAGER |
| Phone | 4077046626 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH25086 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 02995300 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5702940 |
| Name | Role | Address |
|---|---|---|
| JIMENEZ MARIA | Agent | 7333 LAKE UNDERHILL RD, ORLANDO, FL, 32822 |
| Name | Role | Address |
|---|---|---|
| JIMENEZ MARIA | Managing Member | 7333 LAKE UNDERHILL RD, ORLANDO, FL, 32822 |
| JIMENEZ HEDDA | Managing Member | 7333 LAKE UNDERHILL RD, ORLANDO, FL, 32822 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000094666 | CURE AID PHARMACY | EXPIRED | 2010-10-14 | 2015-12-31 | No data | 1049 SO HIAWASSEE RD APT 3418, ORLANDO, FL, 32835 |
| G10000091599 | SUNSTATE PHARMACY | EXPIRED | 2010-10-06 | 2015-12-31 | No data | 1049 S HIAWASSEE RD # 3418, ORLANDO, FL, 32835 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-02-17 | 7333 LAKE UNDERHILL RD, ORLANDO, FL 32822 | No data |
| CHANGE OF MAILING ADDRESS | 2011-02-17 | 7333 LAKE UNDERHILL RD, ORLANDO, FL 32822 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-02-17 | 7333 LAKE UNDERHILL RD, ORLANDO, FL 32822 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-19 |
| ANNUAL REPORT | 2011-02-17 |
| Florida Limited Liability | 2010-10-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
