| Entity Name: | PBJ MEDICAL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Dec 2020 (4 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 05 Feb 2021 (4 years ago) |
| Document Number: | L20000394230 |
| FEI/EIN Number | 86-2378677 |
| Address: | 7512 DR. PHILLIPS BLVD, SUITE 50-247, ORLANDO, FL, 32819, US |
| Mail Address: | 7512 DR. PHILLIPS BLVD, SUITE 50-247, ORLANDO, FL, 32819, US |
| ZIP code: | 32819 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093597544 | 2023-10-19 | 2023-10-19 | 13213 SHADY STABLES LANE, DOVER, FL, 33527, US | 628 MAITLAND AVE, ALTAMONTE SPRINGS, FL, 327016834, US | |||||||||||||||
|
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| Phone | +1 813-215-9855 |
| Phone | +1 800-485-7962 |
Authorized person
| Name | MR. DWAYNE JONES SR. |
| Role | OWNER |
| Phone | 8132159855 |
Taxonomy
| Taxonomy Code | 1835P0018X - Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PRUITT KEVIN | Agent | 7512 DR. PHILLIPS BLVD, ORLANDO, FL, 32819 |
| Name | Role | Address |
|---|---|---|
| PRUITT KEVIN | Manager | 7512 DR. PHILLIPS BLVD, ORLANDO, FL, 32819 |
| BLISS ROBERT | Manager | 7512 DR. PHILLIPS BLVD, ORLANDO, FL, 32819 |
| JONES DWAYNE | Manager | 7512 DR. PHILLIPS BLVD, ORLANDO, FL, 32819 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000044928 | PBJ MEDICAL RX | ACTIVE | 2023-04-08 | 2028-12-31 | No data | 7512 DR. PHILLIPS BLVD, ORLANDO, FL, 32819 |
| G22000040486 | PBJ MEDICAL ASSOCIATES | ACTIVE | 2022-03-30 | 2027-12-31 | No data | 7512 DR. PHILLIPS BLVD, ORLANDO, FL, 32819 |
| G21000029877 | ADVANCED IV INFUSION | ACTIVE | 2021-03-03 | 2026-12-31 | No data | 7512 DR PHILLIPS BLVD SUITE 50-247, ORLANDO, FL, 32819 |
| G21000029894 | PBJ IV INFUSIONS | ACTIVE | 2021-03-03 | 2026-12-31 | No data | 7512 DR PHILLIPS BLVD SUITE 50-247, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2021-02-05 | PBJ MEDICAL, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| ANNUAL REPORT | 2023-03-25 |
| ANNUAL REPORT | 2022-02-27 |
| ANNUAL REPORT | 2021-03-03 |
| LC Name Change | 2021-02-05 |
| Florida Limited Liability | 2020-12-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
