| Entity Name: | ATLANTIC PH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Nov 2017 (7 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 27 Sep 2018 (6 years ago) |
| Document Number: | L17000245611 |
| FEI/EIN Number | 82-3576558 |
| Address: | 3278 LAMANGA DRIVE, MELBOURNE, FL, 32940, US |
| Mail Address: | 3278 LAMANGA DRIVE, MELBOURNE, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477051217 | 2018-01-26 | 2018-07-19 | 3278 LAMANGA DR, MELBOURNE, FL, 329408524, US | 1525 S WICKHAM RD, MELBOURNE, FL, 329043540, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 321-514-4694 |
| Fax | 3218214971 |
| Phone | +1 321-821-4998 |
Authorized person
| Name | NIRMIN NASR |
| Role | MANAGER |
| Phone | 3215144694 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH31134 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2175640 |
| Issuer | MEDICAID |
| Number | 024459300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NASR NIRMIN | Agent | 3278 LAMANGA DRIVE, MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| NASR NIRMIN | Manager | 3278 LAMANGA DRIVE, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-01-04 | NASR, NIRMIN | No data |
| LC STMNT OF RA/RO CHG | 2018-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-09-27 | 3278 LAMANGA DRIVE, MELBOURNE, FL 32940 | No data |
| LC STMNT OF RA/RO CHG | 2018-05-03 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-17 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-07 |
| CORLCRACHG | 2018-09-27 |
| CORLCRACHG | 2018-05-03 |
| Florida Limited Liability | 2017-11-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
