| Entity Name: | PUBLIC SQUARE PHARMACY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 04 Jun 2018 (7 years ago) |
| Document Number: | L18000138117 |
| FEI/EIN Number | 83-0759120 |
| Address: | 11757 BEACH BLVD UNITS, 6 & 7, JACKSONVILLE, FL 32246 |
| Mail Address: | 10415 Docksider Dr W, JACKSONVILLE 32257 UN |
| ZIP code: | 32246 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992273023 | 2018-11-07 | 2018-11-07 | 7836 TIMBERLIN PARK BLVD, JACKSONVILLE, FL, 322565413, US | 11757 BEACH BLVD STE 7, JACKSONVILLE, FL, 322466633, US | |||||||||||||||
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| Phone | +1 941-204-1610 |
| Fax | 9043767718 |
Authorized person
| Name | DIEGO GOMEZ |
| Role | OWNER PHARMACY MANAGER |
| Phone | 9412041610 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PUBLIC SQUARE PHARMACY LLC 401(K) PLAN | 2023 | 830759120 | 2024-07-22 | PUBLIC SQUARE PHARMACY LLC | 4 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-22 |
| Name of individual signing | CHRIS HORNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GOMEZ, DIEGO F, DR. | Agent | 10415 Docksider dr. w, JACKSONVILLE, FL 32257 |
| Name | Role | Address |
|---|---|---|
| Gomez, Diego F | Authorized Person | 10415 Docksider dr. W, Jacksonville, FL 32257 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-17 | 10415 Docksider dr. w, JACKSONVILLE, FL 32257 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-11 | 11757 BEACH BLVD UNITS, 6 & 7, JACKSONVILLE, FL 32246 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-02 | 7836 Timberlin Park Blvd, JACKSONVILLE, FL 32256 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-17 |
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-03-19 |
| ANNUAL REPORT | 2020-09-15 |
| ANNUAL REPORT | 2019-04-02 |
| Florida Limited Liability | 2018-06-04 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4205307406 | 2020-05-08 | 0491 | PPP | 11757 Beach Boulevard, Jacksonville, FL, 32246 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 17 Feb 2025
Sources: Florida Department of State
