| Entity Name: | SRI SAI SANVI INTEGRATIVE PHARMACY SERVICES "LLC" |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Jul 2015 (10 years ago) |
| Document Number: | L15000129318 |
| FEI/EIN Number | 47-5037243 |
| Address: | 1101 BLANDING BOULEVARD, 122, ORANGE PARK, FL, 32065, US |
| Mail Address: | 276 sitara lane, st. johns, FL, 32259, US |
| ZIP code: | 32065 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174981096 | 2016-02-06 | 2017-02-16 | 3515 LAUREL MILL DR, ORANGE PARK, FL, 320655271, US | 1101 BLANDING BLVD STE 122, ORANGE PARK, FL, 320656751, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-644-8038 |
| Fax | 9046448671 |
Authorized person
| Name | NAGARAJU TUMMALA |
| Role | PHARMACY MANAGER/ OWNER / PIC/AO |
| Phone | 9042070355 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH29483 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2157981 |
| Issuer | MEDICAID |
| Number | 016742100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TUMMALA NAGARAJU | Agent | 276 SITARA LANE, ST. JOHNS, FL, 32259 |
| Name | Role | Address |
|---|---|---|
| TUMMALA NAGARAJU | Manager | 276 SITARA LANE, ST. JOHNS, FL, 32259 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000080919 | CARE 1ST PHARMACY | ACTIVE | 2015-08-05 | 2026-12-31 | No data | 276 SITARA LANE, SAINT JOHNS, FL, 32259 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-18 | 276 SITARA LANE, ST. JOHNS, FL 32259 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-13 | 1101 BLANDING BOULEVARD, 122, ORANGE PARK, FL 32065 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-14 |
| ANNUAL REPORT | 2017-03-24 |
| ANNUAL REPORT | 2016-04-07 |
| Florida Limited Liability | 2015-07-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
