| Entity Name: | WORLD TRIUMPH MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 21 Jan 2014 (11 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: | L14000010496 |
| FEI/EIN Number | 59-1796450 |
| Mail Address: | 75 S TUTTLE AVE, SARASOTA, FL, 34237 |
| Address: | 2850 RINGLING BLVD, SARASOTA, FL, 34237 |
| ZIP code: | 34237 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710072830 | 2006-10-04 | 2011-01-25 | 2850 RINGLING BLVD, SARASOTA, FL, 342375346, US | 2850 RINGLING BLVD, SARASOTA, FL, 342375346, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 941-366-0090 |
| Fax | 9419545535 |
Authorized person
| Name | DOUG OLSON |
| Role | MNGER |
| Phone | 9413660090 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH14197 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101129400 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1035915 |
| Name | Role | Address |
|---|---|---|
| OLSON DOUGLAS E | Agent | 75 S TUTTLE AVE, SARASOTA, FL, 34237 |
| Name | Role | Address |
|---|---|---|
| OLSON DRUG CORP. | Authorized Member | 75 S TUTTLE AVE, SARASOTA, FL, 34237 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2016-10-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-02-24 | OLSON, DOUGLAS E | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-02-24 | 75 S TUTTLE AVE, SARASOTA, FL 34237 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-03-28 |
| ANNUAL REPORT | 2017-01-09 |
| REINSTATEMENT | 2016-10-20 |
| ANNUAL REPORT | 2015-02-24 |
| Florida Limited Liability | 2014-01-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
