| Entity Name: | MEDCITY PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 10 Jan 2013 (12 years ago) |
| Document Number: | L13000005239 |
| FEI/EIN Number | 46-1762660 |
| Address: | 463688 SR 200,, SUITE #6, YULEE, FL 32097 |
| Mail Address: | 463688 SR 200,, SUITE #6, YULEE, FL 32097 |
| ZIP code: | 32097 |
| County: | Nassau |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992047260 | 2013-03-25 | 2013-03-25 | 11988 MARLDON LN, JACKSONVILLE, FL, 322589459, US | 463688 SR 200, SUITE #6, YULEE, FL, 32097, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 904-252-1568 |
| Phone | +1 904-432-3810 |
| Fax | 9044323811 |
Authorized person
| Name | SUMANTH EDARA |
| Role | CO-OWNER |
| Phone | 9042521568 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH26731 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5713816 |
| Name | Role | Address |
|---|---|---|
| EDARA, SUMANTH KUMAR | Agent | 463688 SR 200,, SUITE #6, YULEE, FL 32097 |
| Name | Role | Address |
|---|---|---|
| EDARA, NAGARAJA RAJESWARARAO | Managing Member | 169 AMALURRA TRL, SAINT JOHNS, FL 32259 |
| EDARA, SUMANTH | Managing Member | 169 AMALURRA TRL, SAINT JOHNS, FL 32259 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2016-03-10 | EDARA, SUMANTH KUMAR | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-10 | 463688 SR 200,, SUITE #6, YULEE, FL 32097 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-08-20 | 463688 SR 200,, SUITE #6, YULEE, FL 32097 | No data |
| CHANGE OF MAILING ADDRESS | 2013-08-20 | 463688 SR 200,, SUITE #6, YULEE, FL 32097 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-10 |
| ANNUAL REPORT | 2023-04-13 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-01-25 |
| ANNUAL REPORT | 2017-01-05 |
| ANNUAL REPORT | 2016-03-10 |
| ANNUAL REPORT | 2015-02-26 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
