| Entity Name: | PEARL SHAH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Aug 2013 (11 years ago) |
| Document Number: | L13000118277 |
| FEI/EIN Number | 46-3480302 |
| Address: | 6399 38TH AVE NORTH, SUITE A5, ST PETERSBURG, FL, 33710 |
| Mail Address: | 6399 38TH AVE NORTH, SUITE A5, ST PETERSBURG, FL, 33710 |
| ZIP code: | 33710 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831616515 | 2017-08-24 | 2022-07-21 | 6399 38TH AVE N STE A5, SAINT PETERSBURG, FL, 337101651, US | 6399 38TH AVE N STE A5, SAINT PETERSBURG, FL, 337101651, US | |||||||||||||||||||||||||
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| Phone | +1 727-201-9500 |
| Fax | 7272019501 |
Authorized person
| Name | AMIT KUMAR DHIMAN |
| Role | MGRM |
| Phone | 7273895900 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH27659 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PH27659 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DHIMAN AMIT K | Agent | 4400 37th St. S, ST. PETERSBURG, FL, 33710 |
| Name | Role | Address |
|---|---|---|
| DHIMAN AMIT K | Managing Member | 8580 29th way, ST. PETERSBURG, FL, 33782 |
| Name | Role | Address |
|---|---|---|
| Shah Bhavin D | Auth | 1417 HALAPA WAY, TRINITY, FL, 34655 |
| Singh Preet K | Auth | 6399 38TH AVE NORTH, ST PETERSBURG, FL, 33710 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000009777 | ST. PETERSBURG PHARMACY | ACTIVE | 2015-01-28 | 2025-12-31 | No data | 6399 38TH AVE NORTH, SUITE A5, ST PETERSBURG, FL, 3371-0 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-29 | 4400 37th St. S, unit 2, ST. PETERSBURG, FL 33710 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-27 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-01-11 |
| ANNUAL REPORT | 2021-03-24 |
| ANNUAL REPORT | 2020-06-12 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
