| Entity Name: | MARIETTA PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
MARIETTA PHARMACY 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: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 05 Jun 2012 (13 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 23 Apr 2018 (7 years ago) |
| Document Number: | L12000074847 |
| FEI/EIN Number |
45-5456898
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 8299 W. BEAVER ST, JACKSONVILLE, FL, 32220, US |
| Mail Address: | 8299 W. BEAVER ST, JACKSONVILLE, FL, 32220, US |
| ZIP code: | 32220 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912253774 | 2012-07-31 | 2022-02-24 | 8299 W BEAVER ST STE 5, JACKSONVILLE, FL, 322202315, US | 8299 W BEAVER ST STE 5, JACKSONVILLE, FL, 322202315, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-999-4884 |
| Fax | 9049994883 |
Authorized person
| Name | HANESH PATEL |
| Role | RXM |
| Phone | 9049994884 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH26285 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 007212200 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5711189 |
| Name | Role | Address |
|---|---|---|
| PATEL HANESH | Auth | 8299 W. BEAVER ST, JACKSONVILLE, FL, 32220 |
| PATEL HANESH | Agent | 8299 W. BEAVER ST, JACKSONVILLE, FL, 32220 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000057979 | MARIETTA PHARMACY | EXPIRED | 2012-06-12 | 2017-12-31 | - | 8299 W. BEAVER ST #5, JACKSONVILLE, FL, 32220 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-01-25 | PATEL, HANESH | - |
| LC AMENDMENT | 2018-04-23 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2018-01-16 | 8299 W. BEAVER ST, SUITE #5, JACKSONVILLE, FL 32220 | - |
| CHANGE OF MAILING ADDRESS | 2018-01-16 | 8299 W. BEAVER ST, SUITE #5, JACKSONVILLE, FL 32220 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2018-01-16 | 8299 W. BEAVER ST, SUITE #5, JACKSONVILLE, FL 32220 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-21 |
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-04-19 |
| AMENDED ANNUAL REPORT | 2022-09-26 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-02-13 |
| ANNUAL REPORT | 2019-04-11 |
| LC Amendment | 2018-04-23 |
| ANNUAL REPORT | 2018-01-16 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8462117309 | 2020-05-01 | 0491 | PPP | 8299 W BEAVER ST STE 5, JACKSONVILLE, FL, 32220-2315 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Mar 2025
Sources: Florida Department of State
