| Entity Name: | NORTH FLORIDA PHARMACY OF FORT WHITE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Mar 2005 (20 years ago) |
| Document Number: | P05000039211 |
| FEI/EIN Number | 202421107 |
| Address: | 1756 SW BARNETT WAY, LAKE CITY, FL, 32025 |
| Mail Address: | 1756 SW BARNETT WAY, LAKE CITY, FL, 32025 |
| ZIP code: | 32025 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043414782 | 2007-06-14 | 2010-08-13 | 7729 SOUTHWEST US HIGHWAY 27, FORT WHITE, FL, 32038, US | 7729 SW US HIGHWAY 27, FORT WHITE, FL, 320383508, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-497-2580 |
| Fax | 3864974227 |
Authorized person
| Name | DR. KATHLEEN MARSHALL |
| Role | CO-OWNER, PHARMACY MANAGER |
| Phone | 3528710819 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | PH22706 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH22706 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 032073101 |
| State | FL |
| Issuer | MEDICAID |
| Number | 032073100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TORRANS ALFRED W | Agent | 1756 SW BARNETT WAY, LAKE CITY, FL, 32025 |
| Name | Role | Address |
|---|---|---|
| TORRANS ALFRED W | President | 1756 SW BARNETT WAY, LAKE CITY, FL, 32025 |
| Name | Role | Address |
|---|---|---|
| LICHLYTER LYLE | Vice President | 676 TURKEY CREEK, ALACHUA, FL, 32615 |
| Name | Role | Address |
|---|---|---|
| Rosenfeld Joel E | Secretary | 4706 SW SR 47, Lake City, FL, 32024 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-01-06 |
| AMENDED ANNUAL REPORT | 2020-05-04 |
| ANNUAL REPORT | 2020-04-05 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-04-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
