| Entity Name: | MEDIPHARM - RX, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 28 Oct 2004 (20 years ago) |
| Date of dissolution: | 14 Sep 2007 (17 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 14 Sep 2007 (17 years ago) |
| Document Number: | P04000148557 |
| FEI/EIN Number | 20-1658614 |
| Address: | 4607 N CLARK AVE, TAMPA, FL 33614 |
| Mail Address: | 4607 N CLARK AVE, TAMPA, FL 33614 |
| ZIP code: | 33614 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | MEDIPHARM - RX, INC., NEW YORK | 3152348 | NEW YORK |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245275452 | 2006-06-19 | 2020-08-22 | 4607 N CLARK AVE, TAMPA, FL, 336147038, US | 4607 N CLARK AVE, TAMPA, FL, 336147038, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-876-0881 |
| Fax | 8138760883 |
Authorized person
| Name | JOHN HAWES |
| Role | CHIEF PHARMACIST |
| Phone | 8138760881 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH21000 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336I0012X - Institutional Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336M0002X - Mail Order Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | OTHER ID NUMBER-COMMERCIAL NUMBER |
| Number | 1009251 |
| Issuer | MEDICAID |
| Number | 7947131341 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CADDICK, ROBERT L | Agent | 4607 N CLARK AVE, TAMPA, FL 33614 |
| Name | Role | Address |
|---|---|---|
| BOX TED, MICHAEL | Director | 4607 N CLARK AVE, TAMPA, FL 33614 |
| HAWES, JR, JOHN P | Director | CHIEF PHAR., 11531 GLENMONT DR, TAMPA, FL 03635 |
| Name | Role | Address |
|---|---|---|
| GREEN, BRIAN M | Chairman | 4607 N CLARK AVE, TAMPA, FL 33614 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2006-05-04 |
| ANNUAL REPORT | 2005-04-18 |
| Domestic Profit | 2004-10-28 |
Date of last update: 05 Jan 2025
Sources: Florida Department of State
