| Entity Name: | DE2 LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Oct 2017 (7 years ago) |
| Document Number: | L17000211479 |
| FEI/EIN Number | 82-3068654 |
| Address: | 6022 ATLANTIC BLVD, JACKSONVILLE, FL 32211 |
| Mail Address: | 7707 MERRILL RD, #8664, JACKSONVILLE, FL 32239 |
| ZIP code: | 32211 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467954438 | 2018-03-06 | 2022-11-07 | 7707 MERRILL RD UNIT 8664, JACKSONVILLE, FL, 322397728, US | 6022 ATLANTIC BLVD, JACKSONVILLE, FL, 322117503, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-351-6434 |
| Phone | +1 904-990-1054 |
| Fax | 9049901056 |
Authorized person
| Name | KEVIN DUANE |
| Role | MANAGING MEMBER |
| Phone | 9049901054 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH31227 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025153200 |
| State | FL |
| Issuer | PK |
| Number | 2176263 |
| Name | Role | Address |
|---|---|---|
| DUANE, KEVIN J | Agent | 7307 N Main St, JACKSONVILLE, FL 32208 |
| Name | Role | Address |
|---|---|---|
| DUANE, KEVIN J | Manager | 7307 N Main St, JACKSONVILLE, FL 32208 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000111134 | PANAMA PHARMACY #2 | ACTIVE | 2022-09-07 | 2027-12-31 | No data | 7707 MERRILL RD. #8664, JACKSONVILLE, FL, 32239 |
| G19000047881 | PANAMA PHARMACY AT EMED | EXPIRED | 2019-04-17 | 2024-12-31 | No data | 7707 MERRILL RD. #8664, JACKSONVILLE, FL, 32239 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-09-08 | 6022 ATLANTIC BLVD, JACKSONVILLE, FL 32211 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-13 | 7307 N Main St, JACKSONVILLE, FL 32208 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-01-30 |
| ANNUAL REPORT | 2018-03-13 |
| Florida Limited Liability | 2017-10-12 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
