| Entity Name: | MD MOULTON LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
MD MOULTON LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 08 Mar 2012 (13 years ago) |
| Date of dissolution: | 28 Sep 2018 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (7 years ago) |
| Document Number: | L12000033363 |
| FEI/EIN Number |
45-4931044
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL, 32920, US |
| Mail Address: | 8400 Astronaut Blvd, CAPE CANAVERAL, FL, 32920, US |
| ZIP code: | 32920 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336498377 | 2012-09-06 | 2013-02-12 | 8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL, 329204302, US | 8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL, 329204302, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 321-783-7883 |
| Fax | 3217837889 |
Authorized person
| Name | MICHAEL MOULTON |
| Role | OWNER/PHARMACIST |
| Phone | 3217837883 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH26299 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006742800 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5711660 |
| Name | Role | Address |
|---|---|---|
| MOULTON MICHAEL | Managing Member | 8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL, 32920 |
| MOULTON MICHAEL | Agent | 8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL, 32920 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000037652 | MIKE'S PHARMACY | EXPIRED | 2012-04-19 | 2017-12-31 | - | 514 JEFFERSON AVE APT B, CAPE CANAVERAL, FL, 32920 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2015-01-07 | 8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL 32920 | - |
| CHANGE OF MAILING ADDRESS | 2013-04-26 | 8400 ASTRONAUT BLVD, CAPE CANAVERAL, FL 32920 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-07 |
| ANNUAL REPORT | 2016-01-28 |
| ANNUAL REPORT | 2015-01-07 |
| ANNUAL REPORT | 2014-02-04 |
| ANNUAL REPORT | 2013-04-26 |
| Florida Limited Liability | 2012-03-08 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
