| Entity Name: | PINE HILLS DRUGS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 Oct 2002 (22 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 25 Jun 2009 (16 years ago) |
| Document Number: | P02000109870 |
| FEI/EIN Number | 542077292 |
| Address: | 5000 WEST COLONIAL DRIVE, SUITE 100, ORLANDO, FL, 32808, US |
| Mail Address: | 5000 WEST COLONIAL DRIVE, SUITE 100, ORLANDO, FL, 32808, US |
| ZIP code: | 32808 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730286063 | 2006-09-20 | 2024-10-25 | 5000 W COLONIAL DR STE 100, ORLANDO, FL, 328087602, US | 5000 W COLONIAL DR STE 100, ORLANDO, FL, 328087602, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-291-1236 |
| Fax | 4072911797 |
Authorized person
| Name | OSCAR MBIONWU |
| Role | OWNER, PIC, AO |
| Phone | 4072911236 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH19373 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2015749 |
| Issuer | MEDICAID |
| Number | 026164500 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PINE HILLS DRUGS INC 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 542077292 | 2024-06-27 | PINE HILLS DRUGS INC | 5 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-27 |
| Name of individual signing | CHIMEZIRI MBIONWU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-01-01 |
| Business code | 812990 |
| Sponsor’s telephone number | 4072911236 |
| Plan sponsor’s address | 6801 W COLONIAL DR, ORLANDO, FL, 32818 |
Signature of
| Role | Plan administrator |
| Date | 2014-07-31 |
| Name of individual signing | OSCAR MBIONWU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2011-01-01 |
| Business code | 812990 |
| Sponsor’s telephone number | 4072911236 |
| Plan sponsor’s address | 6801 W COLONIAL DR, ORLANDO, FL, 32818 |
Signature of
| Role | Plan administrator |
| Date | 2013-07-30 |
| Name of individual signing | PINE HILLS DRUGS INC |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MBIONWU CHIMEZIRI O | Agent | 2004 HAWKS LANDING DRIVE, ORLANDO, FL, 32820 |
| Name | Role | Address |
|---|---|---|
| MBIONWU CHIMEZIRI O | President | 2004 Hawks Landing Dr., ORLANDO, FL, 32820 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000058602 | PINE HILLS PHARMACY | ACTIVE | 2021-04-28 | 2026-12-31 | No data | 5600 WEST COLONIAL DRIVE, SUITE 316A, ORLANDO, FL, 32808 |
| G14000018501 | P. H. D. PHARMACY & MEDICAL SUPPLIES | EXPIRED | 2014-02-21 | 2019-12-31 | No data | 5600 WEST COLONIAL DRIVE, SUITE 316A, ORLANDO, FL, 32808 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-15 | 5000 WEST COLONIAL DRIVE, SUITE 100, ORLANDO, FL 32808 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-15 | 5000 WEST COLONIAL DRIVE, SUITE 100, ORLANDO, FL 32808 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-21 | 2004 HAWKS LANDING DRIVE, ORLANDO, FL 32820 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-01-15 | MBIONWU, CHIMEZIRI O | No data |
| CANCEL ADM DISS/REV | 2009-06-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-03-20 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-05-11 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-06-30 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-05-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
