| Entity Name: | 1492 PHARMA GROUP CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Oct 2005 (19 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 04 Feb 2020 (5 years ago) |
| Document Number: | P05000136412 |
| FEI/EIN Number | 203635699 |
| Address: | 6420 SW 62ND AVE, SOUTH MIAMI, FL, 33143, US |
| Mail Address: | 6420 SW 62nd Ave, S MIAMI, FL, 33143, US |
| ZIP code: | 33143 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417968058 | 2006-08-10 | 2022-12-12 | 6420 SW 62ND AVE, SOUTH MIAMI, FL, 331433302, US | 6420 SW 62ND AVE, SOUTH MIAMI, FL, 331433302, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-665-4411 |
| Fax | 3056633258 |
Authorized person
| Name | SONIA ELENA MARTINEZ |
| Role | PRESIDENT |
| Phone | 3056654411 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | Yes |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH22048 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 007260700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 019180600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZOMERFELD RAYMOND | Agent | 355 ALHAMBRA CIRCLE, MIAMI, FL, 33143 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ SONIA E | President | 6420 SW 62ND AVE, SOUTH MIAMI, FL, 33143 |
| Name | Role | Address |
|---|---|---|
| Suarez Ivette M | Vice President | 6420 SW 62ND AVE, SOUTH MIAMI, FL, 33143 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G06083900268 | MARCO DRUGS AND COMPOUNDING | ACTIVE | 2006-03-24 | 2026-12-31 | No data | 6627 SOUTH DIXIE HIGHWAY, MIAMI, FL, 33143 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-26 | 6420 SW 62ND AVE, ATTN: SONIA, SOUTH MIAMI, FL 33143 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-26 | 6420 SW 62ND AVE, ATTN: SONIA, SOUTH MIAMI, FL 33143 | No data |
| AMENDMENT | 2020-02-04 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-01-25 | ZOMERFELD, RAYMOND | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-01-25 | 355 ALHAMBRA CIRCLE, STE 1100, MIAMI, FL 33143 | No data |
| AMENDMENT | 2006-08-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-21 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-02-01 |
| Amendment | 2020-02-04 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-01-25 |
| ANNUAL REPORT | 2018-01-08 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-01-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
