| Entity Name: | EMPIRE SPECIALTY PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Feb 2011 (14 years ago) |
| Document Number: | L11000015513 |
| FEI/EIN Number | 274873413 |
| Mail Address: | 1066 Clearlake Road, Cocoa, FL, 32922, US |
| Address: | 378 N Babcock Street, Melbourne, FL, 32935, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093005753 | 2011-04-14 | 2024-10-11 | 1066 CLEARLAKE RD, COCOA, FL, 329226384, US | 378 N BABCOCK ST, MELBOURNE, FL, 329357344, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-549-5005 |
| Fax | 3215496226 |
Authorized person
| Name | VENKATA NAGA LAXMI CHEEDHELLA |
| Role | PRESIDENT |
| Phone | 3215495005 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH25406 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003807200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PENUMUDI MALLIKARJUNA R | Agent | 1066 Clearlake Road, Cocoa, FL, 32922 |
| Name | Role | Address |
|---|---|---|
| CHEEDHELLA VENKATA N | Managing Member | 1066 Clearlake Road, Cocoa, FL, 32922 |
| Name | Role | Address |
|---|---|---|
| PENUMUDI MALLIKARJUNA R | Authorized Person | 1066 Clearlake Road, Cocoa, FL, 32922 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000071614 | APOLLO PHARMACY | ACTIVE | 2022-06-13 | 2027-12-31 | No data | 1451 DIXON BLVD, COCOA, FL, 32922 |
| G12000110806 | EMPIRE HEALTH MART PHARMACY | EXPIRED | 2012-11-15 | 2017-12-31 | No data | 1451 DIXON BLVD, COCOA, FL, 32922 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-03 | 378 N Babcock Street, A, Melbourne, FL 32935 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-03 | 1066 Clearlake Road, Cocoa, FL 32922 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-16 | 378 N Babcock Street, Melbourne, FL 32901 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-07-09 | 378 N Babcock Street, Melbourne, FL 32901 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-05 | 1087 Clearlake Road, Suite A, COCOA, FL 32922 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-03-18 | PENUMUDI, MALLIKARJUNA R | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| ANNUAL REPORT | 2024-01-07 |
| ANNUAL REPORT | 2023-01-05 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-01-19 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-28 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-02-20 |
| ANNUAL REPORT | 2016-01-31 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
