| Entity Name: | LOS PALACIOS MEDICAL SUPPLIES PHARMACY INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Sep 2003 (21 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 08 May 2020 (5 years ago) |
| Document Number: | P03000100807 |
| FEI/EIN Number | 043774285 |
| Address: | 4213 EAST 4TH AVENUE, HIALEAH, FL, 33013-2205, US |
| Mail Address: | 4213 EAST 4TH AVENUE, HIALEAH, FL, 33013-2205, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346274297 | 2006-07-10 | 2023-11-14 | 4213 E 4TH AVE, HIALEAH, FL, 330132305, US | 4213 E 4TH AVE, HIALEAH, FL, 330132305, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 305-688-0644 |
| Fax | 3056880662 |
Authorized person
| Name | DR. ADOLFO M SUAREZ |
| Role | CONSULTANT |
| Phone | 7863016803 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH23304 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2011367 |
| Issuer | MEDICAID |
| Number | 117627900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 008158300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARBALLO ELOINA | Agent | 4213 EAST 4TH AVENUE, HIALEAH, FL, 330132205 |
| Name | Role | Address |
|---|---|---|
| CARBALLO ELOINA | President | 4213 EAST 4TH AVENUE, HIALEAH, FL, 330132205 |
| Name | Role | Address |
|---|---|---|
| CARBALLO ELOINA | Director | 4213 EAST 4TH AVENUE, HIALEAH, FL, 330132205 |
| Name | Role | Address |
|---|---|---|
| MACIAS DAYANA | Vice President | 4213 EAST 4TH AVENUE, HIALEAH, FL, 33013 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000064586 | LOS PALACIOS MEDICAL SUPPLIES & PHARMACY | ACTIVE | 2023-05-24 | 2028-12-31 | No data | 4213 E 4TH AVE, HIALEAH, FL, 33013 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2020-05-08 | No data | No data |
| NAME CHANGE AMENDMENT | 2008-02-05 | LOS PALACIOS MEDICAL SUPPLIES PHARMACY INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| ANNUAL REPORT | 2023-03-24 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-01-14 |
| Amendment | 2020-05-08 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-01-14 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
