| Entity Name: | NIA RX SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 21 Sep 2015 (9 years ago) |
| Document Number: | L15000159623 |
| FEI/EIN Number | 47-5482601 |
| Address: | 500 VONDERBURG DRIVE, STE 113W, BRANDON, FL 33511 |
| Mail Address: | 500 VONDERBURG DRIVE, STE 113W, BRANDON, FL 33511 |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013382662 | 2015-12-08 | 2022-02-22 | 500 VONDERBURG DR STE 113W, BRANDON, FL, 335115969, US | 500 VONDERBURG DR STE 113W, BRANDON, FL, 335115969, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-684-4444 |
| Fax | 8136843444 |
Authorized person
| Name | FALGUN B PATEL |
| Role | MANAGER |
| Phone | 8134205436 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH29589 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2156208 |
| Issuer | MEDICAID |
| Number | 016753800 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NIA RX SERVICES LLC | 2023 | 475482601 | 2024-10-04 | NIA RX SERVICES LLC | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-04 |
| Name of individual signing | FALGUN PATEL |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GUPTA, DEEPAK | Agent | 10350 Meadowrun Dr, Lithia, FL 33547 |
| Name | Role | Address |
|---|---|---|
| GUPTA, DEEPAK, DR | Manager | 10350 Meadowrun Dr, Lithia, FL 33547 |
| Name | Role | Address |
|---|---|---|
| PATEL, FALGUN B | Managing Member | 1235 CARRIAGE PARK DR, VALRICO, FL 33594 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000123188 | BRANDON PHARMACY | ACTIVE | 2015-12-07 | 2025-12-31 | No data | 1035 PROFESSIONAL PARK DR, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-23 | 10350 Meadowrun Dr, Lithia, FL 33547 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-07 | 500 VONDERBURG DRIVE, STE 113W, BRANDON, FL 33511 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-07 | 500 VONDERBURG DRIVE, STE 113W, BRANDON, FL 33511 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-02-17 | GUPTA, DEEPAK | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-23 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-03-22 |
| ANNUAL REPORT | 2020-02-17 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-03-12 |
| ANNUAL REPORT | 2017-04-06 |
| ANNUAL REPORT | 2016-03-09 |
| Florida Limited Liability | 2015-09-21 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
