Entity Name: | PRESTAB CO. |
Jurisdiction: | FLORIDA |
Filing Type: | Domestic Profit |
Status: | Inactive |
Date Filed: | 13 Nov 2002 (22 years ago) |
Document Number: | P02000121139 |
FEI/EIN Number | 200124049 |
Mail Address: | P.O.BOX 831225, MIAMI, FL, 33283 |
Address: | 29943 SOUTH DIXIE HIGHWAY, HOMESTEAD, FL, 33033 |
ZIP code: | 33033 |
County: | Miami-Dade |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1730261033 | 2006-10-19 | 2020-08-22 | 3016 NW 79TH AVE, DORAL, FL, 331221010, US | 3016 NW 79TH AVE, DORAL, FL, 331221010, US | |||||||||||||||||||||||||
|
Phone | +1 305-599-1643 |
Fax | 3055991663 |
Authorized person
Name | MRS. ALEXIS M. BASULTO |
Role | PRESIDENT |
Phone | 3055997000 |
Taxonomy
Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
License Number | PH19462 |
State | FL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 02697010 |
State | FL |
Name | Role | Address |
---|---|---|
GIZ ADELFO | Agent | 29943 SOUTH DIXIE HIGHWAY, HOMESTEAD, FL, 33033 |
Name | Role | Address |
---|---|---|
GIZ ADELFO | President | P.O.BOX 831225, MIAMI, FL, 33283 |
Name | Role | Address |
---|---|---|
GIZ ADELFO | Vice Treasurer | P.O.BOX 831225, MIAMI, FL, 33283 |
Name | Role | Address |
---|---|---|
GIZ ADELFO | Director | P.O.BOX 831225, MIAMI, FL, 33283 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
REINSTATEMENT | 2014-02-26 | No data | No data |
ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
REINSTATEMENT | 2011-08-11 | No data | No data |
ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
AMENDMENT | 2007-03-23 | No data | No data |
AMENDMENT | 2004-08-09 | No data | No data |
Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
---|---|---|---|---|---|---|---|
J12000252786 | LAPSED | 1000000260274 | DADE | 2012-03-22 | 2022-04-06 | $ 573.23 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SOUTH SERVICE CENTER, 8175 NW 12TH ST STE 418, DORAL FL331261828 |
J11000057880 | LAPSED | 08-4861CA 06 | MIAMI-DADE CIRCUIT COURT | 2010-12-02 | 2016-02-01 | $19,691.55 | AMERISOURCEBERGEN DRUG CORP, F/K/A AMERISURE CORP., 2100 DIRECTORS ROW, ORLANDO, FL, 32809 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State