| Entity Name: | THE PRESCRIPTION PLACE OF NICEVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Aug 2014 (10 years ago) |
| Document Number: | L14000135523 |
| FEI/EIN Number | 37-1764215 |
| Address: | 1337 U.S. HIGHWAY 90 WEST, DEFUNIAK SPRINGS, FL, 32433, US |
| Mail Address: | 1337 U.S. HIGHWAY 90 WEST, DEFUNIAK SPRINGS, FL, 32433, US |
| ZIP code: | 32433 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891184859 | 2015-01-14 | 2019-02-05 | 1140 JOHN SIMS PKWY E, SUITE 6, NICEVILLE, FL, 325782204, US | 1140 JOHN SIMS PKWY E, SUITE 6, NICEVILLE, FL, 325782204, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 850-892-6898 |
| Fax | 8503898182 |
| Phone | +1 850-389-8182 |
| Fax | 8503898185 |
Authorized person
| Name | SHANE G ABBOTT |
| Role | OWNER |
| Phone | 8503898182 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH28801 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014786600 |
| State | FL |
| Issuer | FLORIDA STATE LICENSE |
| Number | PH28801 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WEEMS LORI K | Agent | 5810-B HIGHWAY 189 NORTH, BAKER, FL, 32531 |
| Name | Role |
|---|---|
| PRESCRIPTION PLACE OF DEFUNIAK SPRINGS, INC. | Managing Member |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-01-03 |
| ANNUAL REPORT | 2022-01-06 |
| ANNUAL REPORT | 2021-01-06 |
| ANNUAL REPORT | 2020-01-03 |
| ANNUAL REPORT | 2019-01-23 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-01-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
