| Entity Name: | LEWIS PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 Feb 2012 (13 years ago) |
| Document Number: | L12000028169 |
| FEI/EIN Number | 45-4699980 |
| Address: | 7995 Hwy 90, Sneads, FL 32460 |
| Mail Address: | 7995 Hwy 90, Sneads, FL 32460 |
| ZIP code: | 32460 |
| County: | Jackson |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760604904 | 2007-05-03 | 2016-11-01 | 7995 HIGHWAY 90, SNEADS, FL, 324602308, US | 7995 HIGHWAY 90, SNEADS, FL, 324602308, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 850-593-5288 |
| Fax | 8505936462 |
Authorized person
| Name | BRIAN LEWIS |
| Role | PHARMACIST |
| Phone | 8505935288 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH26233 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004659100 |
| State | FL |
| Issuer | PK |
| Number | 2135524 |
| Name | Role | Address |
|---|---|---|
| BONDURANT, FRANK E | Agent | 4450 LAFAYETTE STREET, MARIANNA, FL 32446 |
| Name | Role | Address |
|---|---|---|
| LEWIS, BRIAN | Managing Member | 7995 Hwy 90, Sneads, FL 32460 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000023233 | SNEADS PHARMACY | ACTIVE | 2012-03-07 | 2027-12-31 | No data | 7995 HIGHWAY 90, SNEADS, FL, 32460 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2013-04-02 | 7995 Hwy 90, Sneads, FL 32460 | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-02 | 7995 Hwy 90, Sneads, FL 32460 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-02-11 |
| ANNUAL REPORT | 2020-03-10 |
| ANNUAL REPORT | 2019-03-14 |
| ANNUAL REPORT | 2018-03-20 |
| ANNUAL REPORT | 2017-03-14 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-03-16 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
