| Entity Name: | ISLAND FAMILY PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Mar 2004 (21 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 13 Apr 2004 (21 years ago) |
| Document Number: | P04000051841 |
| FEI/EIN Number | 200937105 |
| Address: | 600 PLANTATION ISL DRIVE, ST. AUGUSTINE, FL, 32080, US |
| Mail Address: | 600 PLANTATION ISLAND DR, ST. AUGUSTINE, FL, 32080, US |
| ZIP code: | 32080 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477666956 | 2006-08-17 | 2016-08-04 | 600 PLANTATION ISLAND DR S, UNIT 3, ST AUGUSTINE, FL, 32080, US | 600 PLANTATION ISLAND DR S, UNIT 3, ST AUGUSTINE, FL, 32080, US | |||||||||||||||||||||||||
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| Phone | +1 904-461-1081 |
| Fax | 9044611082 |
Authorized person
| Name | RYAN CHRISTOPHER BLANCO |
| Role | PRESIDENT/ PHARMACY MANAGER |
| Phone | 9044611081 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH20073 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026812700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLANCO RYAN | Agent | 3485 KINGS RD SOUTH, ST. AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| BLANCO RYAN | President | 3485 KINGS ROAD SOUTH, ST. AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| BLANCO RYAN | Director | 3485 KINGS ROAD SOUTH, ST. AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2013-01-17 | 600 PLANTATION ISL DRIVE, UNIT 3, ST. AUGUSTINE, FL 32080 | No data |
| CHANGE OF MAILING ADDRESS | 2013-01-17 | 600 PLANTATION ISL DRIVE, UNIT 3, ST. AUGUSTINE, FL 32080 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-02-18 | BLANCO, RYAN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-02-18 | 3485 KINGS RD SOUTH, ST. AUGUSTINE, FL 32086 | No data |
| NAME CHANGE AMENDMENT | 2004-04-13 | ISLAND FAMILY PHARMACY, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-20 |
| ANNUAL REPORT | 2024-01-11 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
