| Entity Name: | PALM COAST PHARMACY INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 May 2009 (16 years ago) |
| Document Number: | P09000039025 |
| FEI/EIN Number | 264795308 |
| Address: | 9 PINE CONE DR #109, PALM COAST, FL, 32137, US |
| Mail Address: | 9 PINE CONE DR., #109, PALM COAST, FL, 32137, US |
| ZIP code: | 32137 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962637496 | 2009-05-28 | 2023-03-07 | 9 PINE CONE DRIVE, SUITE 109, PALM COAST, FL, 32137, US | 9 PINE CONE DR, SUITE 109, PALM COAST, FL, 321378686, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 386-597-7400 |
| Fax | 3862467515 |
Authorized person
| Name | VALERIY KRAYTER |
| Role | PRESIDENT |
| Phone | 3865977400 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24188 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001391500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KRAYTER VALERIY | Agent | 9 PINE CONE DR, PALM COAST, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| Krayter Valeriy | President | 9 Pine Cone Dr, Palm Coast, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| Krayter Yelena | Vice President | 9 Pine Cone Dr, Palm Coast, FL, 32137 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-07-02 | KRAYTER, VALERIY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-07-02 | 9 PINE CONE DR, 109, PALM COAST, FL 32137 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-27 | 9 PINE CONE DR #109, PALM COAST, FL 32137 | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-27 | 9 PINE CONE DR #109, PALM COAST, FL 32137 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-21 |
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-17 |
| AMENDED ANNUAL REPORT | 2019-07-02 |
| ANNUAL REPORT | 2019-02-27 |
| AMENDED ANNUAL REPORT | 2018-07-23 |
| ANNUAL REPORT | 2018-01-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
