| Entity Name: | MACK BAYOU PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 20 Jul 2012 (13 years ago) |
| Document Number: | L12000094172 |
| FEI/EIN Number | 46-0622721 |
| Address: | 82 MACK BAYOU LOOP, SUITE B, SANTA ROSA BEACH, FL 32459 |
| Mail Address: | 82 MACK BAYOU LOOP, SUITE B, SANTA ROSA BEACH, FL 32459 |
| ZIP code: | 32459 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | MACK BAYOU PHARMACY, LLC, ALABAMA | 000-312-702 | ALABAMA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508112889 | 2012-07-24 | 2017-03-01 | 82 MACK BAYOU LOOP STE B, SANTA ROSA BEACH, FL, 324592607, US | 82 MACK BAYOU LOOP STE B, SANTA ROSA BEACH, FL, 324592607, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-622-0730 |
| Fax | 8506220755 |
Authorized person
| Name | AMY FRAZIER |
| Role | OWNER |
| Phone | 8506220730 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| License Number | PH26321 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2137562 |
| Name | Role | Address |
|---|---|---|
| MATTHEWS, DANA C | Agent | 4475 LEGENDARY DRIVE, DESTIN, FL 32541 |
| Name | Role |
|---|---|
| AMY A. FRAZIER, INC. | Manager |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-03-12 |
| ANNUAL REPORT | 2020-04-22 |
| ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2018-03-15 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-04-26 |
| ANNUAL REPORT | 2015-05-01 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
