| Entity Name: | RIDGE MANOR PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Dec 2015 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 24 Oct 2023 (a year ago) |
| Document Number: | L15000204924 |
| FEI/EIN Number | 81-0745313 |
| Address: | 34490 CORTEZ BLVD, RIDGE MANOR, FL 33523 |
| Mail Address: | 1042 TULLAMORE DRIVE, WESLEY CHAPEL, FL 33543 |
| ZIP code: | 33523 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922450196 | 2016-07-12 | 2017-01-18 | 9603 ORANGE JASMINE WAY, TAMPA, FL, 336473020, US | 34490 CORTEZ BLVD, RIDGE MANOR, FL, 335238908, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 813-304-2221 |
| Phone | +1 352-437-6851 |
| Fax | 3524376852 |
Authorized person
| Name | BASIM AHMED |
| Role | OWNER |
| Phone | 3526811988 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH30189 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018722900 |
| State | FL |
| Issuer | PK |
| Number | 2160561 |
| Name | Role | Address |
|---|---|---|
| AHMED, BASIM MAHMUD | Agent | 1042 TULLAMORE DRIVE, WESLEY CHAPEL, FL 33543 |
| Name | Role | Address |
|---|---|---|
| AHMED, BASIM MAHMUD | Chief Executive Officer | 1042 TULLAMORE DRIVE, WESLEY CHAPEL, FL 33543 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-10-24 | 34490 CORTEZ BLVD, RIDGE MANOR, FL 33523 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-10-24 | 1042 TULLAMORE DRIVE, WESLEY CHAPEL, FL 33543 | No data |
| REINSTATEMENT | 2023-10-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-10-24 | AHMED, BASIM MAHMUD | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-05-21 | 34490 CORTEZ BLVD, RIDGE MANOR, FL 33523 | No data |
| REINSTATEMENT | 2016-11-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J19000505089 | TERMINATED | 1000000834932 | PASCO | 2019-07-22 | 2039-07-24 | $ 2,557.92 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| REINSTATEMENT | 2023-10-24 |
| ANNUAL REPORT | 2021-05-21 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-04-03 |
| ANNUAL REPORT | 2017-04-26 |
| REINSTATEMENT | 2016-11-03 |
| Florida Limited Liability | 2015-12-08 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
