| Entity Name: | ENVISION PHARMACY AND HEALTHCARE SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 31 Jan 2018 (7 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 18 Nov 2021 (3 years ago) |
| Document Number: | L18000027776 |
| FEI/EIN Number | 82-4223867 |
| Address: | 18125 US HIGHWAY 41 NORTH, SUITE 107, LUTZ, FL 33549 |
| Mail Address: | 18125 US HIGHWAY 41 NORTH, SUITE 107, LUTZ, FL 33549 |
| ZIP code: | 33549 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942954086 | 2022-02-08 | 2022-04-06 | 18125 N US HIGHWAY 41 STE 107, LUTZ, FL, 335494498, US | 18125 N US HIGHWAY 41 STE 107, LUTZ, FL, 335494498, US | |||||||||||||||||||||||||||
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| Phone | +1 813-333-0750 |
| Fax | 8667809023 |
Authorized person
| Name | RAVI YALAMANCHILI |
| Role | OWNER |
| Phone | 8133330750 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 112631900 |
| State | FL |
| Issuer | STATE BOARD OF PHARMACY |
| Number | PH31336 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| YALAMANCHILI, RAVI | Agent | 14707 TUDOR CHASE DR., TAMPA, FL 33626 |
| Name | Role | Address |
|---|---|---|
| YALAMANCHILI, RAVI | MANAGER | 14707 TUDOR CHASE DR., TAMPA, FL 33626 |
| YALAMANCHILI, SHANKAR B | MANAGER | 2732 ANNA STEELE LN., VESTAVIA HILLS, AL 35216 |
| MAHILUM, KATE C | MANAGER | 10144 ARBOR RUN DR., UNIT 28 TAMPA, FL 33647 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-11-18 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-11-18 | 18125 US HIGHWAY 41 NORTH, SUITE 107, LUTZ, FL 33549 | No data |
| CHANGE OF MAILING ADDRESS | 2021-11-18 | 18125 US HIGHWAY 41 NORTH, SUITE 107, LUTZ, FL 33549 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-11-18 | YALAMANCHILI, RAVI | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-11-18 | 14707 TUDOR CHASE DR., TAMPA, FL 33626 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-02-21 |
| LC Amendment | 2021-11-18 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-02-06 |
| Florida Limited Liability | 2018-01-31 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
