| Entity Name: | PRESCRIPTION PLACE OF DEFUNIAK SPRINGS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 30 Sep 2005 (19 years ago) |
| Document Number: | P05000134300 |
| FEI/EIN Number | 20-3551317 |
| Address: | 1337 US HWY 90 WEST, DEFUNIAK SPRINGS, FL 32433 |
| Mail Address: | 1337 US HWY 90 WEST, DEFUNIAK SPRINGS, FL 32433 |
| ZIP code: | 32433 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457370520 | 2006-07-19 | 2015-12-10 | 1337 US HIGHWAY 90 W, DEFUNIAK SPRINGS, FL, 324331470, US | 1337 US HIGHWAY 90 W, DEFUNIAK SPRINGS, FL, 324331470, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-892-6898 |
| Fax | 8508926899 |
Authorized person
| Name | SHANE ABBOTT |
| Role | PHARMACIST |
| Phone | 8508926898 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH21644 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031129400 |
| State | FL |
| Issuer | PK |
| Number | 2005427 |
| Name | Role | Address |
|---|---|---|
| WEEMS, LORI K, P.A. | Agent | 5810-B HIGHWAY 189 NORTH, BAKER, FL 32531 |
| Name | Role | Address |
|---|---|---|
| ABBOTT, SHANE | President | 1337 US HWY 90 WEST, DEFUNIAK SPRINGS, FL 32433 |
| Name | Role | Address |
|---|---|---|
| ABBOTT, SHANE | Director | 1337 US HWY 90 WEST, DEFUNIAK SPRINGS, FL 32433 |
| COLE, CARI | Director | 1337 US HWY 90 WEST, DEFUNIAK SPRINGS, FL 32433 |
| Name | Role | Address |
|---|---|---|
| COLE, CARI | Secretary | 1337 US HWY 90 WEST, DEFUNIAK SPRINGS, FL 32433 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2014-09-02 | 1337 US HWY 90 WEST, DEFUNIAK SPRINGS, FL 32433 | No data |
| CHANGE OF MAILING ADDRESS | 2014-09-02 | 1337 US HWY 90 WEST, DEFUNIAK SPRINGS, FL 32433 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-09-02 | WEEMS, LORI K, P.A. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-09-02 | 5810-B HIGHWAY 189 NORTH, BAKER, FL 32531 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-01-03 |
| ANNUAL REPORT | 2022-01-06 |
| ANNUAL REPORT | 2021-01-06 |
| ANNUAL REPORT | 2020-01-03 |
| ANNUAL REPORT | 2019-01-23 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-01-20 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
