| Entity Name: | SHRI SAIRAM DRUGS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 24 Mar 2017 (8 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 30 May 2017 (8 years ago) |
| Document Number: | L17000068021 |
| FEI/EIN Number | 82-0966444 |
| Address: | 395 W MADISON ST, STARKE, FL 32091 |
| Mail Address: | 395 W MADISON ST, STARKE, FL 32091 |
| ZIP code: | 32091 |
| County: | Bradford |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043356215 | 2007-01-29 | 2018-03-15 | 395 W MADISON ST, STARKE, FL, 32091, US | 395 W MADISON ST, STARKE, FL, 32091, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 904-964-7774 |
| Fax | 9049647807 |
Authorized person
| Name | VENKATAKIRAN KUMAR KALI |
| Role | PRESIDENT |
| Phone | 9722619694 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH19105 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PS31035 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026030400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BORRA, JALANDHAR | Agent | 5268 LOS PALMA VISTA DR, ORLANDO, FL 32837 |
| Name | Role | Address |
|---|---|---|
| Kali, Venkatakiran | Manager | 10203 HENBURY ST, ORLANDO, FL 32832 |
| ALEX, SUSAN | Manager | 9 ELF RD, SYOSSET, NY 11791 |
| BORRA, JALANDHAR | Manager | 5268 LOS PALMA VISTA DR, ORLANDO, FL 32837 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000073790 | MADISON STREET PHARMACY | ACTIVE | 2017-07-10 | 2027-12-31 | No data | 395 W MADISON ST, STARKE, FL, 32091 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-01 | 395 W MADISON ST, STARKE, FL 32091 | No data |
| CHANGE OF MAILING ADDRESS | 2021-02-01 | 395 W MADISON ST, STARKE, FL 32091 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-02-01 | BORRA, JALANDHAR | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-01 | 5268 LOS PALMA VISTA DR, ORLANDO, FL 32837 | No data |
| LC AMENDMENT | 2017-05-30 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-02-09 |
| ANNUAL REPORT | 2022-03-12 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-05-27 |
| ANNUAL REPORT | 2019-02-27 |
| ANNUAL REPORT | 2018-04-25 |
| LC Amendment | 2017-05-30 |
| Florida Limited Liability | 2017-03-24 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
