| Entity Name: | HOLY TRINITY PHARMACY LTC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Oct 2021 (3 years ago) |
| Document Number: | L21000453074 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 10900 State Road 54, Suite 102, Trinity, FL 34655 |
| Mail Address: | 10900 State Road 54, Suite 102, Trinity, FL 34655 |
| ZIP code: | 34655 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265017685 | 2021-03-17 | 2022-05-18 | 10900 STATE ROAD 54 STE 102B, TRINITY, FL, 346552267, US | 10900 STATE ROAD 54 STE 102B, TRINITY, FL, 346552267, US | |||||||||||||||||||||
|
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| Phone | +1 727-312-4384 |
| Fax | 7273124605 |
Authorized person
| Name | NANCY SAMIR AWAD |
| Role | OWNER |
| Phone | 7273124384 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 105889100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ESTAFANOUS, EFFAT | Agent | 10900 STATE ROAD 54, STE 102, TRINITY, FL 34655 |
| Name | Role | Address |
|---|---|---|
| ESTAFANOUS, EFFAT | Manager | 10900 STATE ROAD 54, SUITE 102 TRINITY, FL 34655 |
| Name | Role | Address |
|---|---|---|
| Awad, Nancy | Authorized Member | 10900 State Road 54 Ste 102, Trinity, FL 34655 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-26 | 10900 State Road 54, Suite 102, Trinity, FL 34655 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-26 | 10900 State Road 54, Suite 102, Trinity, FL 34655 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-01-21 |
| ANNUAL REPORT | 2022-03-06 |
| Florida Limited Liability | 2021-10-18 |
Date of last update: 12 Feb 2025
Sources: Florida Department of State
