| Entity Name: | MOULTRIE PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
MOULTRIE PHARMACY, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 04 Feb 2003 (22 years ago) |
| Document Number: | P03000013368 |
| FEI/EIN Number |
542094346
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 3690 US 1 SOUTH, ST AUGUSTINE, FL, 32086 |
| Mail Address: | 3690 US 1 SOUTH, ST AUGUSTINE, FL, 32086 |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740270099 | 2005-10-27 | 2017-03-29 | 3690 US HIGHWAY 1 S, ST AUGUSTINE, FL, 320866498, US | 3690 US HIGHWAY 1 S, ST AUGUSTINE, FL, 320866498, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-794-1399 |
| Fax | 9047941193 |
Authorized person
| Name | DELAINE MCCARTY |
| Role | OWNER |
| Phone | 9047941399 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH19146 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025956000 |
| State | FL |
| Issuer | MEDICAID |
| Number | 025956001 |
| State | FL |
| Issuer | PK |
| Number | 2015438 |
| Issuer | MEDICAID |
| Number | 686878996 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCCARTY DELAINE P | President | 4112 CREEKBLUFF DR, ST AUGUSTINE, FL, 32086 |
| MCCARTY DELAINE P | Director | 4112 CREEKBLUFF DR, ST AUGUSTINE, FL, 32086 |
| MCCARTY ANTHONY O | Secretary | 4112 CREEKBLUFF DRIVE, ST AUGUSTINE, FL, 32086 |
| MCCARTY ANTHONY O | Treasurer | 4112 CREEKBLUFF DRIVE, ST AUGUSTINE, FL, 32086 |
| MCCARTY ANTHONY O | Director | 4112 CREEKBLUFF DRIVE, ST AUGUSTINE, FL, 32086 |
| MCCARTY ANTHONY O | Agent | 4112 CREEKBLUFF DRIVE, ST AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-09-29 | 3690 US 1 SOUTH, ST AUGUSTINE, FL 32086 | - |
| CHANGE OF MAILING ADDRESS | 2009-09-29 | 3690 US 1 SOUTH, ST AUGUSTINE, FL 32086 | - |
| REGISTERED AGENT NAME CHANGED | 2004-03-11 | MCCARTY, ANTHONY O | - |
| REGISTERED AGENT ADDRESS CHANGED | 2004-03-11 | 4112 CREEKBLUFF DRIVE, ST AUGUSTINE, FL 32086 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-01-26 |
| ANNUAL REPORT | 2018-02-06 |
| ANNUAL REPORT | 2017-01-27 |
| ANNUAL REPORT | 2016-03-15 |
| ANNUAL REPORT | 2015-03-31 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 9931997204 | 2020-04-28 | 0491 | PPP | 3690 US 1 South, SAINT AUGUSTINE, FL, 32086 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Apr 2025
Sources: Florida Department of State
