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  5. PARK AVENUE PHARMACY, INC.

PARK AVENUE PHARMACY, INC.

Company Details

Entity Name: PARK AVENUE PHARMACY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 23 Feb 2004 (21 years ago)
Date of dissolution: 23 Sep 2016 (8 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 23 Sep 2016 (8 years ago)
Document Number: P04000037148
FEI/EIN Number 341989603
Address: 4960 HWY 90, MILTON, FL, 32571, US
Mail Address: 4960 HWY 90, MILTON, FL, 32571, US
ZIP code: 32571
County: Santa Rosa
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PARK AVENUE PHARMACY, INC. 401(K) PLAN 2015 341989603 2016-12-29 PARK AVENUE PHARMACY, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 446110
Sponsor’s telephone number 8506232222
Plan sponsor’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570

Signature of
Role Plan administrator
Date 2016-12-29
Name of individual signing TRACEY P. CHASTAIN
Valid signature Filed with authorized/valid electronic signature
PARK AVENUE PHARMACY, INC. 401(K) PLAN 2015 341989603 2016-07-07 PARK AVENUE PHARMACY, INC. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 446110
Sponsor’s telephone number 8506232222
Plan sponsor’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570

Signature of
Role Plan administrator
Date 2016-07-07
Name of individual signing TRACEY P. CHASTAIN
Valid signature Filed with authorized/valid electronic signature
PARK AVENUE PHARMACY, INC. 401(K) PLAN 2014 341989603 2015-10-06 PARK AVENUE PHARMACY, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 446110
Sponsor’s telephone number 8506232222
Plan sponsor’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570

Signature of
Role Plan administrator
Date 2015-10-06
Name of individual signing TRACEY P. CHASTAIN
Valid signature Filed with authorized/valid electronic signature
PARK AVENUE PHARMACY, INC. 401(K) PLAN 2013 341989603 2014-10-08 PARK AVENUE PHARMACY, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 446110
Sponsor’s telephone number 8506232222
Plan sponsor’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570

Signature of
Role Plan administrator
Date 2014-10-08
Name of individual signing TRACEY P. CHASTAIN
Valid signature Filed with authorized/valid electronic signature
PARK AVENUE PHARMACY, INC. 401(K) PLAN 2012 341989603 2013-10-11 PARK AVENUE PHARMACY, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 446110
Sponsor’s telephone number 8506232222
Plan sponsor’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing TRACEY P. CHASTAIN
Valid signature Filed with authorized/valid electronic signature
PARK AVENUE PHARMACY, INC. 401(K) PLAN 2011 341989603 2012-10-10 PARK AVENUE PHARMACY, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 446110
Sponsor’s telephone number 8506232222
Plan sponsor’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570

Plan administrator’s name and address
Administrator’s EIN 341989603
Plan administrator’s name PARK AVENUE PHARMACY, INC.
Plan administrator’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570
Administrator’s telephone number 8506232222

Signature of
Role Plan administrator
Date 2012-10-10
Name of individual signing TRACEY P. CHASTAIN
Valid signature Filed with authorized/valid electronic signature
PARK AVENUE PHARMACY, INC. 401(K) PLAN 2010 341989603 2011-05-23 PARK AVENUE PHARMACY, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-01-01
Business code 446110
Sponsor’s telephone number 8506232222
Plan sponsor’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570

Plan administrator’s name and address
Administrator’s EIN 341989603
Plan administrator’s name PARK AVENUE PHARMACY, INC.
Plan administrator’s address 5440 DOGWOOD DRIVE, MILTON, FL, 32570
Administrator’s telephone number 8506232222

Signature of
Role Plan administrator
Date 2011-05-23
Name of individual signing TRACEY P. CHASTAIN
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
CHASTAIN TRACEY P Agent 4960 HWY 90, MILTON, FL, 32571

President

Name Role Address
CHASTAIN TRACEY P President 4960 HWY 90, MILTON, FL, 32571

Secretary

Name Role Address
CHASTAIN TRACEY P Secretary 4960 HWY 90, MILTON, FL, 32571

Director

Name Role Address
CHASTAIN TRACEY P Director 4960 HWY 90, MILTON, FL, 32571
CHASTAIN LAWRENCE B Director 4960 HWY 90, MILTON, FL, 32571

Vice President

Name Role Address
CHASTAIN LAWRENCE B Vice President 4960 HWY 90, MILTON, FL, 32571

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2016-09-23 No data No data
CHANGE OF PRINCIPAL ADDRESS 2015-03-29 4960 HWY 90, Suite 131, MILTON, FL 32571 No data
CHANGE OF MAILING ADDRESS 2015-03-29 4960 HWY 90, Suite 131, MILTON, FL 32571 No data
REGISTERED AGENT ADDRESS CHANGED 2015-03-29 4960 HWY 90, Suite 131, MILTON, FL 32571 No data

Documents

Name Date
ANNUAL REPORT 2015-03-29
ANNUAL REPORT 2014-03-03
ANNUAL REPORT 2013-01-30
ANNUAL REPORT 2012-01-20
ANNUAL REPORT 2011-02-03
ANNUAL REPORT 2010-01-11
ANNUAL REPORT 2009-01-28
ANNUAL REPORT 2008-01-07
ANNUAL REPORT 2007-04-20
ANNUAL REPORT 2006-04-18

Related by officers

CHASTAIN TRACEY P

SANDJAMMERZ, LLC THE PRESCRIPTION SHOP OF SANTA ROSA, INC.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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