| Entity Name: | OM SHRI GANESH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 May 2011 (14 years ago) |
| Document Number: | L11000061773 |
| FEI/EIN Number | 454774074 |
| Address: | 7628 103RD STREET, UNIT 5, JACKSONVILLE, FL, 32210 |
| Mail Address: | 7628 103RD STREET, UNIT 5, JACKSONVILLE, FL, 32210 |
| ZIP code: | 32210 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720352776 | 2012-03-07 | 2024-03-21 | 7628 103RD ST STE 5, JACKSONVILLE, FL, 322108719, US | 7628 103RD ST STE 5, JACKSONVILLE, FL, 322108719, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 904-900-3500 |
| Fax | 9049003505 |
Authorized person
| Name | TEJAS PATEL |
| Role | MANAGING MEMBER |
| Phone | 9042088137 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH25990 |
| 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 | PK |
| Number | 2134119 |
| Issuer | MEDICAID |
| Number | 006295900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PATEL TEJAS | Agent | 7628 103RD STREET, JACKSONVILLE, FL, 32210 |
| Name | Role | Address |
|---|---|---|
| PATEL M | Managing Member | 7628 103RD STREET, JACKSONVILLE, FL, 32210 |
| PATEL T | Managing Member | 7628 103RD STREET, JACKSONVILLE, FL, 32210 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000054614 | RICKER PHARMACY | EXPIRED | 2011-06-07 | 2016-12-31 | No data | 1269 LEITH HALL DR, SAINT JOHNS, FL, 32259 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2012-08-10 | 7628 103RD STREET, UNIT 5, JACKSONVILLE, FL 32210 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-08-10 | PATEL, TEJAS | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-08-10 | 7628 103RD STREET, UNIT 5, JACKSONVILLE, FL 32210 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-25 | 7628 103RD STREET, UNIT 5, JACKSONVILLE, FL 32210 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-03-30 |
| ANNUAL REPORT | 2022-04-07 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-06-06 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-03-07 |
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-04-08 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
