| Entity Name: | LIFE SPECIALTY PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Nov 2008 (16 years ago) |
| Date of dissolution: | 22 Jul 2010 (15 years ago) |
| Last Event: | VOLUNTARY DISS W/ NOTICE |
| Event Date Filed: | 22 Jul 2010 (15 years ago) |
| Document Number: | P08000103223 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 1507 PARK CENTER DRIVE, SUITE 1L, ORLANDO, FL, 32835 |
| Mail Address: | 1507 PARK CENTER DRIVE, SUITE 1L, ORLANDO, FL, 32835 |
| ZIP code: | 32835 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063650612 | 2009-02-04 | 2009-04-29 | 1507 PARK CENTER DR, SUITE 1L, ORLANDO, FL, 328355795, US | 1507 PARK CENTER DR, SUITE 1L, ORLANDO, FL, 328355795, US | |||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-522-5683 |
| Fax | 4075225684 |
Authorized person
| Name | MICHAEL AYOTUNDE |
| Role | PHARMACIST |
| Phone | 4075225683 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| License Number | PH23699 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336H0001X - Home Infusion Therapy Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1042009 |
| Name | Role | Address |
|---|---|---|
| AYOTUNDE MICHAEL | Agent | 1507 PARK CENTER DRIVE, ORLANDO, FL, 32835 |
| Name | Role | Address |
|---|---|---|
| AYOTUNDE MICHAEL | President | 7459 HIGH LAKE DRIVE, ORLANDO, FL, 32818 |
| Name | Role | Address |
|---|---|---|
| AYOTUNDE ELIZABETH | Vice President | 7459 HIGH LAKE DRIVE, ORLANDO, FL, 32818 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISS W/ NOTICE | 2010-07-22 | No data | No data |
| Name | Date |
|---|---|
| CORAPVDWN | 2010-07-22 |
| ANNUAL REPORT | 2009-04-28 |
| Domestic Profit | 2008-11-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
