| Entity Name: | XTRA CARE PHARMACY INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Jun 2009 (16 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 Apr 2012 (13 years ago) |
| Document Number: | P09000047894 |
| FEI/EIN Number | 270279292 |
| Address: | 6520 U.S. HWY 301, S., STE 106, RIVERVIEW, FL, 33578, US |
| Mail Address: | 6520 U.S. HWY 301, S., STE 106, RIVERVIEW, FL, 33578, US |
| ZIP code: | 33578 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184063455 | 2013-06-20 | 2022-02-17 | 6520 US HIGHWAY 301 S, SUITE 106, RIVERVIEW, FL, 335784347, US | 6520 US HIGHWAY 301 S STE 106, RIVERVIEW, FL, 335784324, US | |||||||||||||||||||||||||||||
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| Phone | +1 813-280-0927 |
| Fax | 8136774500 |
Authorized person
| Name | MILDRED PETERSIDE |
| Role | OWNER/PIC |
| Phone | 8135980593 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH26712 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009181900 |
| State | FL |
| Issuer | PK |
| Number | 2140629 |
| Name | Role | Address |
|---|---|---|
| PETERSIDE MILDRED | Agent | 6520 U.S. HWY 301, S., STE 106, RIVERVIEW, FL, 33578 |
| Name | Role | Address |
|---|---|---|
| PETERSIDE MILDRED | President | 6520 U.S. HWY 301, S., STE 106, RIVERVIEW, FL, 33578 |
| Name | Role | Address |
|---|---|---|
| PETERSIDE MILDRED | Secretary | 6520 U.S. HWY 301, S., STE 106, RIVERVIEW, FL, 33578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-06-11 | 6520 U.S. HWY 301, S., STE 106, RIVERVIEW, FL 33578 | No data |
| CHANGE OF MAILING ADDRESS | 2015-06-11 | 6520 U.S. HWY 301, S., STE 106, RIVERVIEW, FL 33578 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-06-11 | 6520 U.S. HWY 301, S., STE 106, RIVERVIEW, FL 33578 | No data |
| REINSTATEMENT | 2012-04-13 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-07 |
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-03-13 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-03-04 |
| ANNUAL REPORT | 2020-05-07 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-03-16 |
| ANNUAL REPORT | 2017-03-02 |
| ANNUAL REPORT | 2016-03-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
