| Entity Name: | VISTA SPECIALTY PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 15 Jul 2013 (12 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L13000100141 |
| FEI/EIN Number | N/A |
| Mail Address: | 2273 LEE ROAD, WINTER PARK, FL 32789 |
| Address: | 2039 East Edgewood Drive, Lakeland, FL 33803 |
| ZIP code: | 33803 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750712501 | 2013-12-04 | 2016-03-03 | 235 W HWY 50, CLERMONT, FL, 347113027, US | 235 W HIGHWAY 50, CLERMONT, FL, 347113027, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-241-6293 |
| Fax | 3529895849 |
Authorized person
| Name | MEYYAPPAN RAMANATHAN |
| Role | DIRECTOR OF PHARMACY |
| Phone | 5703415728 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| License Number | PH27256 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2143187 |
| Name | Role | Address |
|---|---|---|
| MATHOW, SANDEEP | Agent | 5703 RED BUG LAKE ROAD, #256, WINTER SPRINGS, FL 34711 |
| Name | Role | Address |
|---|---|---|
| MATHOW , SANDEEP | MANAGER | 5703 RED BUG LAKE ROAD, #256 WINTER SPRINGS, FL 34711 |
| Name | Role | Address |
|---|---|---|
| ROHATGI, SWATANTRA | Manager | 5703 RED BUG LAKE ROAD, #256 WINTER SPRINGS, FL 34711 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000028921 | SMART RX PHARMACY | EXPIRED | 2018-02-28 | 2023-12-31 | No data | 5703 RED BUG LAKE ROAD # 256, WINTER SPRINGS, FL, 32708 |
| G14000102802 | KEY HEALTH PHARMACY | EXPIRED | 2014-10-09 | 2019-12-31 | No data | 1500 OAKLEY SEAVER DRIVE, #3, CLERMONT, FL, 34711 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-21 | 2039 East Edgewood Drive, Lakeland, FL 33803 | No data |
| CHANGE OF MAILING ADDRESS | 2019-11-26 | 2039 East Edgewood Drive, Lakeland, FL 33803 | No data |
| LC AMENDMENT | 2017-07-13 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-07-13 | MATHOW, SANDEEP | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-19 | 5703 RED BUG LAKE ROAD, #256, WINTER SPRINGS, FL 34711 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-04-21 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-03-01 |
| LC Amendment | 2017-07-13 |
| ANNUAL REPORT | 2017-04-03 |
| AMENDED ANNUAL REPORT | 2016-06-30 |
| ANNUAL REPORT | 2016-04-19 |
| ANNUAL REPORT | 2015-03-18 |
| ANNUAL REPORT | 2014-04-30 |
| Florida Limited Liability | 2013-07-15 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
