| Entity Name: | LAKELAND CITY PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Sep 2008 (16 years ago) |
| Document Number: | P08000080587 |
| FEI/EIN Number | 263269574 |
| Address: | 106 E. BLUE HERON BLVD., RIVIERA BEACH, FL, 33404, US |
| Mail Address: | P. O. BOX 17175, TAMPA, FL, 33682, US |
| ZIP code: | 33404 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912146507 | 2009-02-05 | 2022-06-15 | PO BOX 17175, TAMPA, FL, 336827175, US | 106 E BLUE HERON BLVD, RIVIERA BEACH, FL, 334044543, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 561-818-2233 |
| Fax | 5617290987 |
Authorized person
| Name | STEPHEN O BANJOKO |
| Role | CFO |
| Phone | 8133414000 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH23820 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2118838 |
| Issuer | MEDICAID |
| Number | 104357200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BANJOKO BAMIDELE | Agent | 10549 N FLORIDA AVE.,, TAMPA, FL, 33612 |
| Name | Role | Address |
|---|---|---|
| BANJOKO STEPHEN O | Chief Financial Officer | P. O. BOX 17175, TAMPA, FL, 33682 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000043070 | BAY AREA PHARMACY | ACTIVE | 2023-04-04 | 2028-12-31 | No data | 1721 W FLETCHER AVE, TAMPA, FL, 33612 |
| G18000038396 | SOUTH PASADENA PHARMACY | EXPIRED | 2018-03-22 | 2023-12-31 | No data | 1206 PASADENA AVENUE S, SOUTH PASADENA, FL, 33707-6202 |
| G12000043952 | SOUTH PASADENA PHARMACY | EXPIRED | 2012-05-10 | 2017-12-31 | No data | 1206 PASADENA AVENUE SOUTH, SOUTH PASADENA, FL, 33707 |
| G08248900314 | LAKELAND COMMUNITY PHARMACY | EXPIRED | 2008-09-04 | 2013-12-31 | No data | 1231 ALPINE LAKE DRIVE, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-04 | 106 E. BLUE HERON BLVD., RIVIERA BEACH, FL 33404 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-30 | 10549 N FLORIDA AVE.,, SUITE A, TAMPA, FL 33612 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-10 | 106 E. BLUE HERON BLVD., RIVIERA BEACH, FL 33404 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-03-10 | BANJOKO, BAMIDELE | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000120822 | TERMINATED | 1000000982317 | PINELLAS | 2024-02-22 | 2044-02-28 | $ 21,465.08 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-04-30 |
| AMENDED ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2021-03-10 |
| AMENDED ANNUAL REPORT | 2020-09-14 |
| ANNUAL REPORT | 2020-06-19 |
| ANNUAL REPORT | 2019-03-20 |
| ANNUAL REPORT | 2018-03-27 |
| ANNUAL REPORT | 2017-03-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
