| Entity Name: | MOON LAKE PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Jul 2007 (18 years ago) |
| Date of dissolution: | 28 Jan 2008 (17 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 28 Jan 2008 (17 years ago) |
| Document Number: | P07000082934 |
| Address: | 9111 RIDGE ROAD, NEW PORT RICHEY, FL, 34654 |
| Mail Address: | 9111 RIDGE ROAD, NEW PORT RICHEY, FL, 34654 |
| ZIP code: | 34654 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053500066 | 2007-10-16 | 2007-10-16 | 9111 RIDGE RD, NEW PORT RICHEY, FL, 346545059, US | 9111 RIDGE RD, NEW PORT RICHEY, FL, 346545059, US | |||||||||||||||||||
|
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| Phone | +1 727-846-1800 |
| Fax | 7278461822 |
Authorized person
| Name | MRS. VIVIAN ALBERTO |
| Role | PRESIDENT |
| Phone | 7278461800 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH 22873 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ALBERTO VIVIAN | Agent | 9111 RIDGE ROAD, NEW PORT RICHEY, FL, 34654 |
| Name | Role | Address |
|---|---|---|
| ALBERTO VIVIAN | President | 9111 RIDGE ROAD, NEW PORT RICHEY, FL, 34654 |
| Name | Role | Address |
|---|---|---|
| GUSTMAN TYLER | Vice President | 9111 RIDGE ROAD, NEW PORT RICHEY, FL, 34654 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2008-01-28 | No data | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2008-01-28 |
| Domestic Profit | 2007-07-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
