| Entity Name: | SOUTHERN HILLS PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jun 2014 (11 years ago) |
| Document Number: | L14000091359 |
| FEI/EIN Number | 471038874 |
| Address: | 840 SW 81st Ave, North Lauderdale, FL, 33068, US |
| Mail Address: | 840 SW 81st Ave, North Lauderdale, FL, 33068, US |
| ZIP code: | 33068 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265831978 | 2014-08-19 | 2017-02-15 | 1739 N UNIVERSITY DR, PLANTATION, FL, 333224111, US | 1739 N UNIVERSITY DR, PLANTATION, FL, 333224111, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 850-590-2622 |
| Fax | 9549908125 |
Authorized person
| Name | GARVEY PINKSTON |
| Role | CEO |
| Phone | 8505902622 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH29133 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2152202 |
| Issuer | MEDICAID |
| Number | 015407100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Pinkston Kaydiann C | Agent | 840 SW 81st Ave, North Lauderdale, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| PINKSTON GARVEY RII | Managing Member | 840 SW 81st Ave, North Lauderdale, FL, 33068 |
| Pinkston Kaydiann | Managing Member | 840 SW 81st Ave, North Lauderdale, FL, 33068 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-26 | 840 SW 81st Ave, Suite 6, North Lauderdale, FL 33068 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-26 | 840 SW 81st Ave, Suite 6, North Lauderdale, FL 33068 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-26 | 840 SW 81st Ave, Suite 6, North Lauderdale, FL 33068 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-05-03 | Pinkston, Kaydiann C | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-03-29 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-06-26 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-02-02 |
| ANNUAL REPORT | 2017-05-03 |
| ANNUAL REPORT | 2016-04-06 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
