| Entity Name: | ELLENTON DISCOUNT PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Sep 2015 (9 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 07 Apr 2022 (3 years ago) |
| Document Number: | L15000153411 |
| FEI/EIN Number | 47-5078302 |
| Address: | 8324 US 301 NORTH, PARRISH, FL, 34219, US |
| Mail Address: | 8324 US 301 NORTH, PARRISH, FL, 34219, US |
| ZIP code: | 34219 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780103481 | 2017-09-13 | 2018-07-19 | 8324 US HIGHWAY 301 N, PARRISH, FL, 342198653, US | 8324 US HIGHWAY 301 N, PARRISH, FL, 342198653, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 941-444-2233 |
| Fax | 9414177144 |
Authorized person
| Name | KUNJAL PATEL |
| Role | PHARMACIST |
| Phone | 9414442233 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH29831 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017320800 |
| State | FL |
| Issuer | PK |
| Number | 2175537 |
| Name | Role | Address |
|---|---|---|
| PATEL KUNJAL | Agent | 8324 US 301 NORTH, PARRISH, FL, 34219 |
| Name | Role | Address |
|---|---|---|
| PATEL KUNJAL | President | 8324 US 301 NORTH, PARRISH, FL, 34219 |
| Name | Role | Address |
|---|---|---|
| PATEL DARSHANA | Authorized Member | 5612 CLOVERLEAF RUN, LAKEWOOD RANCH, FL, 34211 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2022-04-07 | No data | No data |
| REINSTATEMENT | 2016-12-07 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-12-07 | PATEL, KUNJAL | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-01-23 |
| LC Amendment | 2022-04-07 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-03-31 |
| ANNUAL REPORT | 2020-06-25 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-03-07 |
| ANNUAL REPORT | 2017-04-26 |
| REINSTATEMENT | 2016-12-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
