| Entity Name: | AVA KEROLOS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 04 Apr 2013 (12 years ago) |
| Date of dissolution: | 19 Aug 2022 (2 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 19 Aug 2022 (2 years ago) |
| Document Number: | L13000049693 |
| FEI/EIN Number | 46-2378530 |
| Address: | 1739 MAPLE LEAF BLVD, OLDSMAR, FL, 34677, US |
| Mail Address: | 1739 MAPLE LEAF BLVD, OLDSMAR, FL, 34677, US |
| ZIP code: | 34677 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659764959 | 2015-03-10 | 2021-12-28 | 33338 U.S. HWY 19 N., PALM HARBOR, FL, 34684, US | 33338 U.S. HWY 19 N., PALM HARBOR, FL, 34684, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-785-2650 |
| Fax | 7277852827 |
| Phone | +1 727-785-2640 |
| Fax | 7277840701 |
Authorized person
| Name | EMAN ROUFAIL |
| Role | OWNER |
| Phone | 6155548105 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH28867 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014789900 |
| State | FL |
| Issuer | PK |
| Number | 2150855 |
| Name | Role | Address |
|---|---|---|
| ROUFAIL EMAN | Agent | 1739 MAPLE LEAF BLVD, OLDSMAR, FL, 34677 |
| Name | Role | Address |
|---|---|---|
| ROUFAIL EMAN | Managing Member | 1739 MAPLE LEAF BLVD, OLDSMAR, FL, 34677 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000035033 | GOOD SAMARITAN PHARMACY | ACTIVE | 2016-04-06 | 2026-12-31 | No data | 1739 MAPLE LEAF BLVD, OLDSMAR, FL, 34677 |
| G15000034180 | GOOD SAMARITAN PHARMACY | ACTIVE | 2015-04-03 | 2025-12-31 | No data | 1739 MAPLELEAF BLVD, OLDSMAR, FL, 34677 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-08-19 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-01-23 | ROUFAIL, EMAN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-23 | 1739 MAPLE LEAF BLVD, OLDSMAR, FL 34677 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-08-19 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-05 |
| ANNUAL REPORT | 2020-02-19 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-01-23 |
| AMENDED ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2016-04-14 |
| AMENDED ANNUAL REPORT | 2015-06-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
