| Entity Name: | MERIDIAN PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Dec 2014 (10 years ago) |
| Document Number: | L14000185437 |
| FEI/EIN Number | 47-2456313 |
| Address: | 4202 W WATERS AVE,, TAMPA, FL, 33614, US |
| Mail Address: | 5838 Bent Grass Dr, Valrico, FL, 33596, US |
| ZIP code: | 33614 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821479510 | 2015-06-18 | 2017-03-31 | 4202 W WATERS AVE STE 2, TAMPA, FL, 336141972, US | 4202 W WATERS AVE STE 2, TAMPA, FL, 336141972, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-374-0395 |
| Fax | 8136055860 |
Authorized person
| Name | CHERIAN CHERIAN |
| Role | MANAGER/OWNER |
| Phone | 8134045691 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH29042 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2152480 |
| Issuer | MEDICAID |
| Number | 015127200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHERIAN CHERRIAN K | Agent | 5838 BENT GRASS DR, VALRICO, FL, 33596 |
| Name | Role | Address |
|---|---|---|
| CHERIAN CHERRIAN K | Manager | 5838 BENT GRASS DR, VALRICO, FL, 33596 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-17 | 4202 W WATERS AVE,, SUITE #2, TAMPA, FL 33614 | No data |
| CHANGE OF MAILING ADDRESS | 2015-01-24 | 4202 W WATERS AVE,, SUITE #2, TAMPA, FL 33614 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-22 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-03-02 |
| ANNUAL REPORT | 2019-02-17 |
| ANNUAL REPORT | 2018-02-10 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-01-04 |
| ANNUAL REPORT | 2015-01-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
