| Entity Name: | SHIVOAM LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 16 Apr 2019 (6 years ago) |
| Date of dissolution: | 07 Nov 2024 (3 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 07 Nov 2024 (3 months ago) |
| Document Number: | L19000104700 |
| FEI/EIN Number | 83-4537707 |
| Address: | 319 S WOODLAND BLVD, DELAND, FL 32720 |
| Mail Address: | 3232 Players View Cir, Longwood, FL 32779 |
| ZIP code: | 32720 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134194202 | 2006-02-21 | 2023-03-07 | 319 S WOODLAND BLVD, DELAND, FL, 32720, US | 319 S WOODLAND BLVD, DELAND, FL, 32720, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 386-734-3383 |
| Fax | 3867343384 |
Authorized person
| Name | HARDIK G SHAH |
| Role | OWNER |
| Phone | 3522725944 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | PH11083 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH11083 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| License Number | PH11083 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | OTHER ID NUMBER-COMMERCIAL NUMBER |
| Number | 1064512 |
| Issuer | MEDICAID |
| Number | 109020800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHAH, HARDIK | Agent | 319 S WOODLAND BLVD, DELAND, FL 32720 |
| Name | Role | Address |
|---|---|---|
| SHAH, HARDIK | Manager | 1285 DUSTY PINE DR, APOPKA, FL 32703 |
| PATEL, VIRAT | Manager | 2044 SOLAR DR, WINTER GARDEN, FL 34787 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-11-07 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2023-08-25 | 319 S WOODLAND BLVD, DELAND, FL 32720 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-18 | 319 S WOODLAND BLVD, DELAND, FL 32720 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-04-18 | 319 S WOODLAND BLVD, DELAND, FL 32720 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-11-07 |
| ANNUAL REPORT | 2024-02-17 |
| ANNUAL REPORT | 2023-08-25 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-04-18 |
| Florida Limited Liability | 2019-04-16 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
