| Entity Name: | BURGOS PHARMACY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Sep 2019 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 18 Nov 2019 (5 years ago) |
| Document Number: | L19000230423 |
| FEI/EIN Number | 84-3125174 |
| Address: | 9527 SW 40 ST, MIAMI, FL 33165 |
| Mail Address: | 9527 SW 40 ST, MIAMI, FL 33165 |
| ZIP code: | 33165 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427696830 | 2019-12-16 | 2024-05-22 | 9527 SW 40TH ST, MIAMI, FL, 331654035, US | 9527 SW 40TH ST, MIAMI, FL, 331654035, US | |||||||||||||||||||||||||||||
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| Phone | +1 305-374-9003 |
| Fax | 3053749034 |
Authorized person
| Name | LILIBET BURGOS |
| Role | PHARMACY MANAGER |
| Phone | 3053749003 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE NSC |
| Number | 8196810001 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BURGOS, LILIBET | Agent | 9527 SW 40TH ST, MIAMI, FL 33165 |
| Name | Role | Address |
|---|---|---|
| BURGOS, LILIBET | Authorized Member | 9527 SW 40TH ST, MIAMI, FL 33165 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-12-05 | 9527 SW 40 ST, MIAMI, FL 33165 | No data |
| CHANGE OF MAILING ADDRESS | 2019-12-05 | 9527 SW 40 ST, MIAMI, FL 33165 | No data |
| LC AMENDMENT | 2019-11-18 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-11-18 | 9527 SW 40TH ST, MIAMI, FL 33165 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-01-25 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-11 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-01-31 |
| LC Amendment | 2019-11-18 |
| Florida Limited Liability | 2019-09-11 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
