| Entity Name: | INTERNAL MEDICINE ASSOCIATES OF LEE COUNTY PHARMACY GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 14 Feb 2011 (14 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | L11000019673 |
| Address: | 1400 COLONIAL BLVD., STE. 1, FT. MYERS, FL, 33907 |
| Mail Address: | 1400 COLONIAL BLVD., STE. 1, FT. MYERS, FL, 33907 |
| ZIP code: | 33907 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255628095 | 2011-06-30 | 2011-10-14 | 13813 METRO PKWY, FORT MYERS, FL, 339124343, US | 13813 METRO PKWY, FORT MYERS, FL, 339124343, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-938-1725 |
| Fax | 2059706766 |
Authorized person
| Name | BARBARA WEITER |
| Role | CONTROLLER |
| Phone | 2059702263 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH25555 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0002X - Clinic Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5707407 |
| Name | Role | Address |
|---|---|---|
| SPILMAN NATALIA | Agent | 1400 COLONIAL BLVD., STE. 1, FT. MYERS, FL, 33907 |
| Name | Role | Address |
|---|---|---|
| COLLIER MICHAEL | Managing Member | 1400 COLONIAL BLVD., STE. 1, FT. MYERS, FL, 33907 |
| Name | Role | Address |
|---|---|---|
| ZELLNER STEPHEN | Manager | 1400 COLONIAL BLVD., STE. 1, FT. MYERS, FL, 33907 |
| AXELROD DANIEL D | Manager | 2885 KEDLESTON CIRCLE, FT. MYERS, FL, 33912 |
| BALDINGER DAVID D | Manager | 6645 PLANTATION PRESERVE CIR N, FT. MYERS, FL, 33966 |
| CLAKR JACK | Manager | 10636 THRONWOOD DRIVE, FT. MYERS, FL, 33908 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2011-02-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
