| Entity Name: | RX-MART PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Nov 2012 (12 years ago) |
| Document Number: | L12000150119 |
| FEI/EIN Number | 46-2394430 |
| Address: | 655 STATE ROAD 207, SUITE 101, ST AUGUSTINE, FL 32084 |
| Mail Address: | 655 STATE ROAD 207, SUITE 101, ST AUGUSTINE, FL 32084 |
| ZIP code: | 32084 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366871774 | 2013-11-06 | 2015-06-02 | 665 STATE ROAD 207, SUITE 101, ST AUGUSTINE, FL, 320845938, US | 665 STATE ROAD 207, SUITE 101, ST AUGUSTINE, FL, 320845938, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-342-2162 |
| Fax | 9045472732 |
Authorized person
| Name | SWAPNA KONDU |
| Role | PIC |
| Phone | 9043422162 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH27104 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2142731 |
| Issuer | MEDICAID |
| Number | 010548300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Gulati Law,PL | Agent | 479 Montgomery PL, Altamonte Springs, FL 32714 |
| Name | Role | Address |
|---|---|---|
| shakhamoori, sowjanya | President | 665 state rd 207, suite101 st augustine, FL 32804 |
| Name | Role | Address |
|---|---|---|
| Boga, Omprakash | Manager | 655 STATE ROAD 207, SUITE 101 ST AUGUSTINE, FL 32084 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-04-11 | Gulati Law,PL | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-11 | 479 Montgomery PL, Altamonte Springs, FL 32714 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-06-06 | 655 STATE ROAD 207, SUITE 101, ST AUGUSTINE, FL 32084 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-03-05 |
| ANNUAL REPORT | 2021-04-11 |
| ANNUAL REPORT | 2020-04-10 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-01-26 |
| ANNUAL REPORT | 2017-01-04 |
| ANNUAL REPORT | 2016-03-27 |
| AMENDED ANNUAL REPORT | 2015-02-20 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
