| Entity Name: | ZEPHYRHILLS PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Aug 2017 (7 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 06 Sep 2017 (7 years ago) |
| Document Number: | L17000180460 |
| FEI/EIN Number | 82-2825888 |
| Address: | 36600 STATE ROAD 54, ZEPHYRHILLS, FL, 33541, US |
| Mail Address: | 36600 STATE ROAD 54, ZEPHYRHILLS, FL, 33541, US |
| ZIP code: | 33541 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427562412 | 2017-11-29 | 2018-05-31 | 36600 STATE ROAD 54, ZEPHYRHILLS, FL, 335416940, US | 36600 STATE ROAD 54, ZEPHYRHILLS, FL, 33541, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 813-220-6863 |
Authorized person
| Name | BHAGAVAN GOTTIPATI |
| Role | PHARMACY MANAGER/OWNER |
| Phone | 8138157000 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH31046 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 024126900 |
| State | FL |
| Issuer | FLORIDA BOARD OF PHARMACY |
| Number | PH31046 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOTTIPATI BHAGAVAN | Agent | 36600 STATE ROAD 54, ZEPHYRHILLS, FL, 33541 |
| Name | Role | Address |
|---|---|---|
| GOTTIPATI BHAGAVAN | Authorized Member | 36600 STATE ROAD 54, ZEPHYRHILLS, FL, 33541 |
| Name | Role | Address |
|---|---|---|
| Gottipati Sudharani | Auth | 36600 STATE ROAD 54, ZEPHYRHILLS, FL, 33541 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000087511 | OMEGA PHARMACY | EXPIRED | 2019-08-19 | 2024-12-31 | No data | 36600 STATE ROAD 54, ZEPHYRHILLS, FL, 33541 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2017-09-06 | ZEPHYRHILLS PHARMACY LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-03-20 |
| ANNUAL REPORT | 2020-06-11 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-28 |
| LC Name Change | 2017-09-06 |
| Florida Limited Liability | 2017-08-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
