| Entity Name: | FLETCHER DISCOUNT PHARMACY INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 05 Oct 2006 (18 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P06000127700 |
| FEI/EIN Number | 611510509 |
| Address: | 3450 EAST FLETCHER AVENUE, #140, TAMPA, FL, 33613 |
| Mail Address: | 3450 EAST FLETCHER AVENUE, #140, TAMPA, FL, 33613 |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619032042 | 2006-12-26 | 2012-09-12 | 3450 E FLETCHER AVE, STE 140, TAMPA, FL, 336134655, US | 3450 E FLETCHER AVE, STE 140, TAMPA, FL, 336134655, US | |||||||||||||||||||||||||||||
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| Phone | +1 813-977-2013 |
| Fax | 8134417255 |
Authorized person
| Name | RANDOLPH MCEWEN |
| Role | PRESIDENT |
| Phone | 8139772013 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH22386 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031837000 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1023833 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FLETCHER DISCOUNT PHARMACY INC 401 K PROFIT SHARING PLAN TRUST | 2010 | 611510509 | 2011-07-13 | FLETCHER DISCOUNT PHARMACY INC | 4 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 611510509 |
| Plan administrator’s name | FLETCHER DISCOUNT PHARMACY INC |
| Plan administrator’s address | 3450 E.FLETCHER AVE SUITE 140, TAMPA, FL, 33613 |
| Administrator’s telephone number | 8139979010 |
Signature of
| Role | Plan administrator |
| Date | 2011-07-13 |
| Name of individual signing | FLETCHER DISCOUNT PHARMACY INC |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2008-01-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 8139979010 |
| Plan sponsor’s address | 3450 E.FLETCHER AVE SUITE 140, TAMPA, FL, 33613 |
Plan administrator’s name and address
| Administrator’s EIN | 611510509 |
| Plan administrator’s name | FLETCHER DISCOUNT PHARMACY INC |
| Plan administrator’s address | 3450 E.FLETCHER AVE SUITE 140, TAMPA, FL, 33613 |
| Administrator’s telephone number | 8139979010 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-02 |
| Name of individual signing | FLETCHER DISCOUNT PHARMACY INC |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2008-01-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 8139979010 |
| Plan sponsor’s address | 3450 E.FLETCHER AVE SUITE 140, TAMPA, FL, 33613 |
Plan administrator’s name and address
| Administrator’s EIN | 611510509 |
| Plan administrator’s name | FLETCHER DISCOUNT PHARMACY INC |
| Plan administrator’s address | 3450 E.FLETCHER AVE SUITE 140, TAMPA, FL, 33613 |
| Administrator’s telephone number | 8139979010 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-26 |
| Name of individual signing | FLETCHER DISCOUNT PHARMACY INC |
| Valid signature | Filed with incorrect/unrecognized electronic signature |
| Name | Role | Address |
|---|---|---|
| MCEWEN RANDOLPH E | Agent | 3450 E. FLETCHER AVE., TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| MCEWEN RANDOLPH E | President | 10006 CROSS CREEK BOULEVARD # 102, TAMPA, FL, 33647 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08003900353 | NEXT DOSE PHARMACY | EXPIRED | 2008-01-03 | 2013-12-31 | No data | 3450 EAST FLETCHER AVENUE, 140, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| CANCEL ADM DISS/REV | 2010-04-13 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-13 | 3450 EAST FLETCHER AVENUE, #140, TAMPA, FL 33613 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2007-02-20 | MCEWEN, RANDOLPH E | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-02-20 | 3450 E. FLETCHER AVE., #140, TAMPA, FL 33613 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-09-21 |
| ANNUAL REPORT | 2011-01-18 |
| REINSTATEMENT | 2010-04-13 |
| ANNUAL REPORT | 2008-04-29 |
| ANNUAL REPORT | 2007-07-30 |
| Reg. Agent Change | 2007-02-20 |
| Domestic Profit | 2006-10-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
