| Entity Name: | QLA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Apr 2024 (10 months ago) |
| Last Event: | LC DISSOCIATION MEM |
| Event Date Filed: | 09 Jul 2024 (7 months ago) |
| Document Number: | L24000161120 |
| Address: | 1145 SW 17TH LANE, 4, GAINESVILLE, FL, 32601, US |
| Mail Address: | 12433 NW 17TH PL, CORAL SPRINGS, FL, 33071, US |
| ZIP code: | 32601 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447271531 | 2006-07-22 | 2008-11-25 | 4655 NW 7TH ST, MIAMI, FL, 331262308, US | 4655 NW 7TH ST, MIAMI, FL, 331262308, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-445-3700 |
| Fax | 3054419188 |
Authorized person
| Name | MR. ARMANDO QUESADA |
| Role | OWNER |
| Phone | 3054453700 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH13284 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022210100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AZAR ALEXANDER P | Agent | 11973 NW 66TH CT, PARKLAND, FL, 33076 |
| Name | Role | Address |
|---|---|---|
| QUINLAN THOMAS J | Manager | 12433 NW 17TH PL, CORAL SPRINGS, FL, 33071 |
| WESTON MAXWELL T | Manager | 6991 NW 111TH TERRACE, PARKLAND, FL, 33076 |
| LUBIN AIDAN J | Manager | 9767 RIVERSIDE DRIVE, CORAL SPRINGS, FL, 33071 |
| AZAR ALEXANDER P | Manager | 11973 NW 66TH CT, PARKLAND, FL, 33076 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC DISSOCIATION MEM | 2024-07-09 | No data | No data |
| Name | Date |
|---|---|
| CORLCDSMEM | 2024-07-09 |
| Florida Limited Liability | 2024-04-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
