| 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 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | MYCELIUM PHARMACY LLC, NEW YORK | 6475599 | NEW YORK |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487252391 | 2020-10-13 | 2020-10-13 | 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 333341623, US | 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 333341623, US | |||||||||||||
|
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| Phone | +1 954-616-5675 |
Authorized person
| Name | MR. MARKO JARIC |
| Role | OWNER |
| Phone | 9546165675 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LAUTER DREW E | Agent | 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 33334 |
| Name | Role | Address |
|---|---|---|
| LAUTER DREW E | Manager | 141 E COMMERCIAL BLVD, FT LAUDERDALE, FL, 33334 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-10-17 | LAUTER, DREW E | No data |
| 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 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
