| Entity Name: | NIMOH PHARMACY AND COMPOUNDING LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Jun 2014 (11 years ago) |
| Document Number: | L14000088710 |
| FEI/EIN Number | 46-5639792 |
| Address: | 12878 US HIGHWAY 301, DADE CITY, FL, 33525 |
| Mail Address: | 12878 US HIGHWAY 301, DADE CITY, FL, 33525, US |
| ZIP code: | 33525 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053729418 | 2014-07-30 | 2024-05-29 | 12878 US HIGHWAY 301, DADE CITY, FL, 335255801, US | 12878 US HIGHWAY 301, DADE CITY, FL, 335255801, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 352-437-5985 |
| Fax | 3524375986 |
Authorized person
| Name | DADDY NIMOH BOATENG |
| Role | P.I.C / OWNER |
| Phone | 3524375985 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH28347 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012884100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BOATENG DADDY N | Agent | 12878 US HIGHWAY 301, DADE CITY, FL, 33525 |
| Name | Role | Address |
|---|---|---|
| BOATENG DADDY N | Manager | 20024 DATE PALM WAY, TAMPA, FL, 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2015-04-29 | 12878 US HIGHWAY 301, DADE CITY, FL 33525 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-29 | 12878 US HIGHWAY 301, DADE CITY, FL 33525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-16 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-28 |
| ANNUAL REPORT | 2019-03-16 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-03-11 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
