| Entity Name: | TAMPA LONG TERM CARE PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Sep 2011 (13 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 05 Oct 2015 (9 years ago) |
| Document Number: | L11000108675 |
| FEI/EIN Number | 45-3356700 |
| Address: | 4801 GEORGE RD SUITE 190, TAMPA, FL 33634 |
| Mail Address: | 4801 GEORGE RD SUITE 190, TAMPA, FL 33634 |
| ZIP code: | 33634 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669749453 | 2011-11-21 | 2017-02-16 | 4801 GEORGE RD STE 190, TAMPA, FL, 336346200, US | 4801 GEORGE RD STE 190, TAMPA, FL, 336346200, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-886-2023 |
| Fax | 8133747417 |
Authorized person
| Name | ROBERT BENNETT |
| Role | OWNER |
| Phone | 8138862023 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH25772 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2132687 |
| Issuer | MEDICAID |
| Number | 017401800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| eyer, james w, jr | Agent | 4801 George Road, Suite 190, SUITE 101, TAMPA, FL 33634 |
| Name | Role | Address |
|---|---|---|
| EYER, JAMES W, JR | Manager | 4801 GEORGE RD SUITE 190, TAMPA, FL 33634 |
| BENNETT, ROBERT | Manager | 4801 GEORGE RD SUITE 190, TAMPA, FL 33634 |
| JACOBSON, MATTHEW | Manager | 4801 GEORGE RD SUITE 190, TAMPA, FL 33634 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000124736 | MEDS TO HOME | EXPIRED | 2019-11-21 | 2024-12-31 | No data | 4801 GEORGE RD SUITE 190, TAMPA, FL, 33634 |
| G16000041244 | ASL PHARMACY | EXPIRED | 2016-04-23 | 2021-12-31 | No data | 4801 GEORGE ROAD, STE 190, TAMPA, FL, 33634 |
| G12000088094 | MEDS TO HOME | EXPIRED | 2012-09-07 | 2017-12-31 | No data | 1033 STATE ROAD 436, SUITE 237, CASSELBERRY, FL, 32707 |
| G11000093825 | TAMPA LTC | EXPIRED | 2011-09-22 | 2016-12-31 | No data | 14508 N. FLORIDA AVE, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-04-30 | eyer, james w, jr | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-30 | 4801 George Road, Suite 190, SUITE 101, TAMPA, FL 33634 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-23 | 4801 GEORGE RD SUITE 190, TAMPA, FL 33634 | No data |
| LC AMENDMENT | 2015-10-05 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2015-10-05 | 4801 GEORGE RD SUITE 190, TAMPA, FL 33634 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| ANNUAL REPORT | 2023-04-23 |
| ANNUAL REPORT | 2022-04-09 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-05-03 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-20 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-23 |
| LC Amendment | 2015-10-05 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
