| Entity Name: | LAKELAND FAMILY PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 18 Jun 2013 (12 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L13000088999 |
| FEI/EIN Number | 46-3695251 |
| Address: | 850 HANOVER WAY, LAKELAND, FL 33813 |
| Mail Address: | 850 HANOVER WAY, LAKELAND, FL 33813 |
| ZIP code: | 33813 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467827840 | 2015-12-10 | 2015-12-10 | 427 E CENTRAL AVE, WINTER HAVEN, FL, 338803051, US | 427 E CENTRAL AVE, WINTER HAVEN, FL, 338803051, US | |||||||||||||||||||||
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| Phone | +1 863-698-7938 |
Authorized person
| Name | TIMOTHY CLAY |
| Role | MANAGING PARTNER |
| Phone | 8636195269 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH29489 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2155855 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKELAND FAMILY PHARMACY 401(K) PLAN | 2016 | 463695251 | 2017-11-21 | LAKELAND FAMILY PHARMACY, LLC | 1 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2017-11-21 |
| Name of individual signing | TIMOTHY CLAY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2017-11-21 |
| Name of individual signing | TIMOTHY CLAY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-02-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 8636987260 |
| Plan sponsor’s address | 605 W. MEMORIAL BLVD, LAKELAND, FL, 338151466 |
Signature of
| Role | Plan administrator |
| Date | 2017-07-13 |
| Name of individual signing | TIMOTHY CLAY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2017-07-13 |
| Name of individual signing | TIMOTHY CLAY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-02-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 8636987260 |
| Plan sponsor’s address | 605 W. MEMORIAL BLVD, LAKELAND, FL, 338151466 |
Signature of
| Role | Plan administrator |
| Date | 2016-07-20 |
| Name of individual signing | TIMOTHY CLAY |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2016-07-20 |
| Name of individual signing | TIMOTHY CLAY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| ARTMAN, STEPHEN H, ESQ | Agent | 925 SOUTH FLORIDA AVENUE, LAKELAND, FL 33803 |
| Name | Role | Address |
|---|---|---|
| CLAY, TIMOTHY P | Managing Member | 850 HANOVER WAY, LAKELAND, FL 33813 |
| BARKER, HAROLD E | Managing Member | 1109 LAKE POINT TERRACE, LAKELAND, FL 33813 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2017-10-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-10-01 | ARTMAN, STEPHEN H, ESQ | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-04 |
| REINSTATEMENT | 2017-10-01 |
| ANNUAL REPORT | 2016-03-15 |
| ANNUAL REPORT | 2015-01-15 |
| ANNUAL REPORT | 2014-02-20 |
| Florida Limited Liability | 2013-06-18 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
