| Entity Name: | PINES DISCOUNT PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 24 Aug 2004 (20 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | P04000122102 |
| FEI/EIN Number | 201546345 |
| Address: | 2020 KINGSLEY AVE, ORANGE PARK, FL, 32073, US |
| Mail Address: | 2020 KINGSLEY AVE, ORANGE PARK, FL, 32073, US |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265934723 | 2018-03-01 | 2018-03-01 | 631 NW 100TH PL, PEMBROKE PINES, FL, 330246163, US | 631 NW 100TH PL, PEMBROKE PINES, FL, 330246163, US | |||||||||||||||||||||||||
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| Phone | +1 954-437-4900 |
| Fax | 9544374504 |
Authorized person
| Name | ADEKUNLE ADIMULA |
| Role | PRESIDENT |
| Phone | 9544374900 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH24151 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 030963000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DALY JESSICA | Agent | 2020 KINGSLEY AVE, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| DALY JESSICA | President | 2020 KINGSLEY AVE, ORANGE PARK, FL, 32073 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000111587 | KINGSLEY PHARMACY | ACTIVE | 2021-08-29 | 2026-12-31 | No data | 2020 KINGSLEY AVE, ORANGE PARK, FL, 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-10-07 | 2020 KINGSLEY AVE, SUITE 2B, ORANGE PARK, FL 32073 | No data |
| CHANGE OF MAILING ADDRESS | 2021-10-07 | 2020 KINGSLEY AVE, SUITE 2B, ORANGE PARK, FL 32073 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-09-24 | DALY, JESSICA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-09-24 | 2020 KINGSLEY AVE, SUITE 2A, ORANGE PARK, FL 32073 | No data |
| AMENDMENT | 2021-01-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-04-11 |
| AMENDED ANNUAL REPORT | 2021-10-12 |
| Reg. Agent Change | 2021-09-24 |
| Off/Dir Resignation | 2021-09-24 |
| Reg. Agent Resignation | 2021-09-24 |
| ANNUAL REPORT | 2021-03-29 |
| Amendment | 2021-01-25 |
| ANNUAL REPORT | 2020-06-16 |
| ANNUAL REPORT | 2019-03-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
