| Entity Name: | MORTAR & PESTLE PHARMACY INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 07 Nov 2003 (21 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | P03000133255 |
| FEI/EIN Number | 58-2679095 |
| Address: | 12920 SW 119TH STREET, MIAMI, FL 33186 |
| Mail Address: | 12920 SW 119TH STREET, MIAMI, FL 33186 |
| ZIP code: | 33186 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689757726 | 2006-10-23 | 2012-08-08 | 12920 SW 119TH ST, MIAMI, FL, 331864506, US | 12920 SW 119TH ST, MIAMI, FL, 331864506, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 305-603-9958 |
| Fax | 3056039958 |
Authorized person
| Name | MERCEDES SILVA |
| Role | PIC |
| Phone | 3057759021 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH22625 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1022728 |
| Issuer | MEDICAID |
| Number | 031999600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SILVA, MERCEDES | Agent | 12920 SW 119TH STREET, MIAMI, FL 33186 |
| Name | Role | Address |
|---|---|---|
| SILVA, MERCEDES | Chief Executive Officer | 12920 SW 119TH STREET, MIAMI, FL 33186 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000069169 | MORTAR & PESTLE GIFT & BEATY BAR | EXPIRED | 2011-07-11 | 2016-12-31 | No data | 900 SOUTH MIAMI AVENUE, SUITE 143, MIAMI, FL, 33130 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-16 | 12920 SW 119TH STREET, MIAMI, FL 33186 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-16 | 12920 SW 119TH STREET, MIAMI, FL 33186 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-16 | 12920 SW 119TH STREET, MIAMI, FL 33186 | No data |
| AMENDMENT | 2008-07-25 | No data | No data |
| AMENDMENT | 2006-09-22 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J10000007879 | LAPSED | 08-76276 CA 31 | 11TH DADE COUNTY CIRCUIT COURT | 2010-01-07 | 2015-01-12 | $237,590.46 | H.D. SMITH WHOLESALE DRUG COMPANY, 3063 FIAT AVENUE, SPRINGFIELD, IL 62703 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-16 |
| ANNUAL REPORT | 2011-03-21 |
| ANNUAL REPORT | 2010-04-21 |
| ANNUAL REPORT | 2009-03-04 |
| Amendment | 2008-07-25 |
| ANNUAL REPORT | 2008-03-31 |
| ANNUAL REPORT | 2007-02-20 |
| Amendment | 2006-09-22 |
| ANNUAL REPORT | 2006-08-23 |
| ANNUAL REPORT | 2005-04-25 |
Date of last update: 05 Jan 2025
Sources: Florida Department of State
