| Entity Name: | LAKE PLACID PHARMACY INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 17 Jan 2006 (19 years ago) |
| Date of dissolution: | 26 Sep 2008 (16 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2008 (16 years ago) |
| Document Number: | P06000006752 |
| FEI/EIN Number | 14-1950494 |
| Address: | 224 E. INTERLAKE BLVD, LAKE PLACID, FL 33852 |
| Mail Address: | 1707 DIVOT DRIVE, SEBRING, FL 33872 |
| ZIP code: | 33852 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558404442 | 2007-02-14 | 2014-04-11 | 6360 US 27 N, SEBRING, FL, 338701225, US | 224 E INTERLAKE BLVD, LAKE PLACID, FL, 338529603, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 863-385-5588 |
| Fax | 8634653977 |
Authorized person
| Name | ROBERT DUNCAN |
| Role | OWNER AND PRESIDENT |
| Phone | 8633855588 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH21893 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | OTHER ID NUMBER-COMMERCIAL NUMBER |
| Number | 1021031 |
| Issuer | MEDICAID |
| Number | 031423400 |
| State | FL |
| Issuer | OTHER ID NUMBER |
| Number | 1021031 |
| Name | Role | Address |
|---|---|---|
| DUNCAN, ROBERT E | Agent | 300 FIFTH AVENUE SOUTH, SUITE 101-330, NAPLES, FL 34102 |
| Name | Role | Address |
|---|---|---|
| DUNCAN, ROBERT | Director | 1707 DIVOT DRIVE, SEBRING, FL 33872 |
| DUNCAN, CAROLIN W | Director | 1707 DIVOT LANE, SEBRING, FL 33872 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-05-08 | 300 FIFTH AVENUE SOUTH, SUITE 101-330, NAPLES, FL 34102 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-04-30 | 224 E. INTERLAKE BLVD, LAKE PLACID, FL 33852 | No data |
| REGISTERED AGENT NAME CHANGED | 2007-04-30 | DUNCAN, ROBERT E | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2007-04-30 |
| Domestic Profit | 2006-01-17 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
