| Entity Name: | NORTH FLORIDA PHARMACY OF MAYO, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 28 Apr 2003 (22 years ago) |
| Document Number: | P03000049076 |
| FEI/EIN Number | 13-4244272 |
| Mail Address: | 1756 SW BARNETT WAY, LAKE CITY, FL 32025 |
| Address: | 229 W MAIN ST., MAYO, FL 32066 |
| ZIP code: | 32066 |
| County: | Lafayette |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487674271 | 2006-07-21 | 2008-05-12 | 229 WEST MAIN STREET, PO BOX 1510, MAYO, FL, 32066, US | 229 WEST MAIN STREET/ BOX 1510, MAYO, FL, 32066, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 386-294-3777 |
Authorized person
| Name | VICKY S NOLING |
| Role | CO-OWNER/MANAGER |
| Phone | 3862943777 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026343500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 026343501 |
| State | FL |
| Issuer | BLUE CROSS/BLUE SHIELD |
| Number | P8389 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TORRANS, ALFRED WII | Agent | 1756 SW BARNETT WAY, LAKE CITY, FL 32025 |
| Name | Role | Address |
|---|---|---|
| ROSENFELD, JOEL E | Director | RT 15 BOX 3094, LAKE CITY, FL 32024 |
| Name | Role | Address |
|---|---|---|
| LUMBERT, CHERRY | Secretary | PO BOX 65, BRANFORD, FL 32008 |
| Name | Role | Address |
|---|---|---|
| NOLING, VICKY S | President | 9320 232ST, O'BRINE, FL 32071 |
| Name | Role | Address |
|---|---|---|
| MIDDLETON, JAMES S | Vice President | PO BOX 1881, LAKE CITY, FL 32056 |
| Name | Role | Address |
|---|---|---|
| TORRANS II, ALFRED WII | Treasurer | PO BOX 1463, LAKE CITY, FL 32056 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2004-01-20 | 229 W MAIN ST., MAYO, FL 32066 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-04-05 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-16 |
| ANNUAL REPORT | 2015-04-16 |
Date of last update: 06 Jan 2025
Sources: Florida Department of State
