| Entity Name: | WICKHAM DISCOUNT PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Feb 2013 (12 years ago) |
| Document Number: | L13000031171 |
| FEI/EIN Number | 46-2170247 |
| Address: | 1060 N. Wickham Road, Melbourne, FL, 32935, US |
| Mail Address: | 1060 N. Wickham Road, Melbourne, FL, 32935, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265868665 | 2013-09-18 | 2014-11-19 | 1060 N WICKHAM RD, MELBOURNE, FL, 329358937, US | 1060 N WICKHAM RD, MELBOURNE, FL, 329358937, US | |||||||||||||||||||||||||||||
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| Phone | +1 321-241-6433 |
| Fax | 3212416434 |
Authorized person
| Name | ANKIT SHAH |
| Role | OWNER, PHCY MGR, PIC |
| Phone | 3212416433 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH26906 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010488000 |
| State | FL |
| Issuer | PK |
| Number | 2142537 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WICKHAM PHARMACY 401(K) PLAN | 2023 | 462170247 | 2024-10-09 | WICKHAM DISCOUNT PHARMACY LLC | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-09 |
| Name of individual signing | ANKIT SHAH |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SHAH ANKIT | Agent | 1060 N. Wickham Road, Melbourne, FL, 32935 |
| Name | Role | Address |
|---|---|---|
| SHAH ANKIT | President | 6044 ANELLO DRIVE, MELBOURNE, FL, 32940 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000034582 | WICKHAM PHARMACY | ACTIVE | 2013-04-10 | 2028-12-31 | No data | 6044 ANELLO DR, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-11 | 1060 N. Wickham Road, Melbourne, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-11 | 1060 N. Wickham Road, Melbourne, FL 32935 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-11 | SHAH, ANKIT | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-11 | 1060 N. Wickham Road, Melbourne, FL 32935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-02-17 |
| ANNUAL REPORT | 2021-01-17 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-03-21 |
| ANNUAL REPORT | 2018-04-22 |
| ANNUAL REPORT | 2017-02-20 |
| ANNUAL REPORT | 2016-03-16 |
| ANNUAL REPORT | 2015-04-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
