| Entity Name: | NORTH FLORIDA PHARMACY OF KEYSTONE HEIGHTS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 11 Oct 2006 (18 years ago) |
| Document Number: | P06000129760 |
| FEI/EIN Number | 20-5676670 |
| 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 | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568525186 | 2006-12-18 | 2015-10-16 | 405 S LAWRENCE BLVD, KEYSTONE HEIGHTS, FL, 326569222, US | 405 S LAWRENCE BLVD, KEYSTONE HEIGHTS, FL, 326569222, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 352-478-2057 |
| Fax | 3524782059 |
Authorized person
| Name | JAMES AUTRY |
| Role | PHARMACY MANAGER |
| Phone | 3524782057 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH22412 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031978300 |
| State | FL |
| Issuer | MEDICAID |
| Number | 031978301 |
| State | FL |
| Issuer | PK |
| Number | 2008196 |
| Name | Role | Address |
|---|---|---|
| TORRANS, ALFRED WII | Agent | 1756 SW BARNETT WAY, LAKE CITY, FL 32025 |
| Name | Role | Address |
|---|---|---|
| TORRANS, ALFRED WII | President | 1756 SW BARNETT WAY, LAKE CITY, FL 32025 |
| Name | Role | Address |
|---|---|---|
| SANFORD, ALYSSA W | Vice President | 658 NW 171 ST, STARKE, FL 32091 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-04-22 |
| 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 |
| ANNUAL REPORT | 2015-04-16 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
