| Entity Name: | NEPTUNE BEACH PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 16 Apr 2012 (13 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | L12000051431 |
| FEI/EIN Number | 45-5060909 |
| Address: | 1529 ATLANTIC BOULEVARD, NEPTUNE BEACH, FL, 32266 |
| Mail Address: | 1529 ATLANTIC BOULEVARD, NEPTUNE BEACH, FL, 32266 |
| ZIP code: | 32266 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518212182 | 2012-07-19 | 2012-11-14 | 1529 ATLANTIC BLVD, NEPTUNE BEACH, FL, 322661717, US | 1529 ATLANTIC BLVD, NEPTUNE BEACH, FL, 322661717, US | |||||||||||||||||||||||
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| Phone | +1 904-685-4919 |
| Fax | 9046852390 |
Authorized person
| Name | EDET SAMPSON |
| Role | PHARMACIST OWNER |
| Phone | 9046193450 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH26227 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5710911 |
| Name | Role | Address |
|---|---|---|
| SAMPSON EDET U | Agent | 1668 HIDDEN FOREST LANE, JACKSONVILLE, FL, 32225 |
| Name | Role | Address |
|---|---|---|
| SAMPSON EDET U | Managing Member | 1668 HIDDEN FOREST LANE, JACKSONVILLE, FL, 32225 |
| Name | Role | Address |
|---|---|---|
| SAMPSON ANIEKAN U | Vice President | 2054 RIVERSIDE AVENUE, Jacksonville, FL, 32204 |
| SAMPSON GRACE U | Vice President | 1668 HIDDEN FOREST LANE, JACKSONVILLE, FL, 32225 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REINSTATEMENT | 2015-07-16 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-07-16 | SAMPSON, EDET U | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-26 |
| ANNUAL REPORT | 2016-03-25 |
| REINSTATEMENT | 2015-07-16 |
| Florida Limited Liability | 2012-04-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
