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MYCELIUM PHARMACY LLC - Florida Company Profile

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Company Details

Entity Name: MYCELIUM PHARMACY LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 24 Jun 2020 (5 years ago)
Document Number: L20000176319
FEI/EIN Number 85-1601130
Address: 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 33334, US
Mail Address: 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 33334, US
ZIP code: 33334
City: Fort Lauderdale
County: Broward
Place of Formation: FLORIDA

Links between entities

Type:
Headquarter of
Company Number:
6475599
State:
NEW YORK

Key Officers & Management

Name Role Address
LAUTER DREW E Manager 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 33334
LAUTER DREW E Agent 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 33334

National Provider Identifier

NPI Number:
1487252391
Certification Date:
2025-03-18

Authorized Person:

Name:
MR. DREW LAUTER
Role:
MANAGER/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
333600000X - Pharmacy
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G25000044337 PHARMAX ACTIVE 2025-03-31 2030-12-31 - 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 33334

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2024-10-17 LAUTER, DREW E -

Documents

Name Date
AMENDED ANNUAL REPORT 2024-10-17
ANNUAL REPORT 2024-04-29
ANNUAL REPORT 2023-03-08
ANNUAL REPORT 2022-03-07
ANNUAL REPORT 2021-01-28
Florida Limited Liability 2020-06-24

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Date of last update: 03 Jul 2025

Sources: Florida Department of State