| Entity Name: | EXTRA CARE CITY PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 May 2016 (9 years ago) |
| Document Number: | L16000100384 |
| FEI/EIN Number | 812619627 |
| Address: | 1000 EXECUTIVE DRIVE, OVIEDO, FL, 32765, US |
| Mail Address: | 1000 EXECUTIVE DRIVE, SUITE 2, OVIEDO, FL, 32765, US |
| ZIP code: | 32765 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861942740 | 2016-10-04 | 2021-09-24 | 1000 EXECUTIVE DR, OVIEDO, FL, 327658140, US | 1000 EXECUTIVE DR STE 2, OVIEDO, FL, 327658140, US | |||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||
| Phone | +1 716-816-5252 |
| Fax | 4075425164 |
| Phone | +1 407-890-9241 |
Authorized person
| Name | UCHENNA OBIDIKE |
| Role | PHARMACY MANAGER |
| Phone | 7168165252 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH30389 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2164639 |
| Issuer | MEDICAID |
| Number | 020010800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| OBIDIKE UCHENNA | Agent | 1000 EXECUTIVE DRIVE, OVIEDO, FL, 32765 |
| Name | Role | Address |
|---|---|---|
| OBIDIKE UCHENNA | Auth | 1000 EXECUTIVE DRIVE, OVIEDO, FL, 32765 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2017-04-28 | 1000 EXECUTIVE DRIVE, OVIEDO, FL 32765 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-28 | 1000 EXECUTIVE DRIVE, SUITE 2, OVIEDO, FL 32765 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-06-02 | 1000 EXECUTIVE DRIVE, OVIEDO, FL 32765 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-03-29 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-16 |
| ANNUAL REPORT | 2020-03-25 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-09-14 |
| ANNUAL REPORT | 2017-04-28 |
| Florida Limited Liability | 2016-05-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
