Entity Name: | TITUSVILLE PHARMACY, LLC |
Jurisdiction: | FLORIDA |
Filing Type: | Florida Limited Liability Company |
Status: | Active |
Date Filed: | 12 Nov 2010 (14 years ago) |
Document Number: | L10000117882 |
FEI/EIN Number | 80-0661578 |
Address: | 2175 CHENEY HWY, STE B, TITUSVILLE, FL 32780 |
Mail Address: | 2175 CHENEY HWY, SUITE B, TITUSVILLE, FL 32780 |
ZIP code: | 32780 |
County: | Brevard |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1073800579 | 2011-07-05 | 2014-11-21 | 2175 CHENEY HWY STE B, TITUSVILLE, FL, 327806792, US | 2175 CHENEY HWY STE B, TITUSVILLE, FL, 327806792, US | |||||||||||||||||||||||||||||||||||||||||||
|
Phone | +1 321-268-0911 |
Fax | 3212680918 |
Authorized person
Name | ARVINDBHAI PATEL |
Role | OWNER |
Phone | 4074886851 |
Taxonomy
Taxonomy Code | 333600000X - Pharmacy |
Is Primary | No |
Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
License Number | PH25543 |
State | FL |
Is Primary | Yes |
Taxonomy Code | 3336C0004X - Compounding Pharmacy |
Is Primary | No |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 004155200 |
State | FL |
Issuer | PK |
Number | 2131551 |
Issuer | MEDICAID |
Number | 004155201 |
State | FL |
Name | Role | Address |
---|---|---|
PATEL, PRAGNESH | Agent | 2175 CHENEY HWY, SUITE B, TITUSVILLE, FL 32780 |
Name | Role | Address |
---|---|---|
PATEL, PRAGNESH | Manager | 2175 CHENEY HWY, SUITE B, TITUSVILLE, FL 32780 |
Shah, Ronak | Manager | 2808 Wyndham Way, Melbourne, FL 32940 |
Patel, Mital | Manager | 10854 Lago Bella Drive, Orlando, FL 32832 |
Patel, Narendra | Manager | 13358 Alderley Drive, Orlando, FL 32832 |
Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
---|---|---|---|---|---|---|
G18000078756 | TITUSVILLE DISCOUNT PHARMACY | ACTIVE | 2018-07-20 | 2028-12-31 | No data | 2175 CHENEY HIGHWAY, SUITE B, TITUSVILLE, FL, 32780 |
G10000105073 | TITUSVILLE DISCOUNT PHARMACY | EXPIRED | 2010-11-16 | 2015-12-31 | No data | 6801 NORTH US HWY 1, SUITE 1, COCOA, FL, 32927 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
CHANGE OF MAILING ADDRESS | 2013-01-28 | 2175 CHENEY HWY, STE B, TITUSVILLE, FL 32780 | No data |
REGISTERED AGENT ADDRESS CHANGED | 2013-01-28 | 2175 CHENEY HWY, SUITE B, TITUSVILLE, FL 32780 | No data |
CHANGE OF PRINCIPAL ADDRESS | 2012-02-12 | 2175 CHENEY HWY, STE B, TITUSVILLE, FL 32780 | No data |
Name | Date |
---|---|
ANNUAL REPORT | 2024-04-08 |
AMENDED ANNUAL REPORT | 2023-11-08 |
ANNUAL REPORT | 2023-03-02 |
ANNUAL REPORT | 2022-03-11 |
ANNUAL REPORT | 2021-04-01 |
AMENDED ANNUAL REPORT | 2020-08-13 |
ANNUAL REPORT | 2020-02-03 |
ANNUAL REPORT | 2019-02-12 |
ANNUAL REPORT | 2018-02-22 |
ANNUAL REPORT | 2017-02-24 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State