| Entity Name: | MEDOZ PHARMACY OF OSCEOLA INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 12 Nov 2009 (15 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | P09000092873 |
| FEI/EIN Number | 271315859 |
| Address: | 720 WEST OAK STREET, 114, KISSIMMEE, FL, 34741, US |
| Mail Address: | 2038 Autumn View Dr, Orlando, FL, 32825, US |
| ZIP code: | 34741 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083921860 | 2010-09-01 | 2012-09-17 | 720 W OAK ST, STE 114, KISSIMMEE, FL, 347414989, US | 720 W OAK ST, STE 114, KISSIMMEE, FL, 347414989, US | |||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 407-374-2550 |
| Fax | 4073474097 |
Authorized person
| Name | UDAYKUMAR DESAI |
| Role | CEO |
| Phone | 4073742550 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0002X - Clinic Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 24831 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106499034 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5701556 |
| Name | Role | Address |
|---|---|---|
| Desai Udaykumar | Agent | 2038 Autumn View Dr, Orlando, FL, 32825 |
| Name | Role | Address |
|---|---|---|
| ANBALAGAN SUNDARAMPILLAI | President | 13726 LAKE CAWOOD DRIVE, WINDERMERE, FL, 34786 |
| Name | Role | Address |
|---|---|---|
| DESAI VIRAL V | Chief Financial Officer | 3483 DUNBAR LANE, SUWANEE, GA, 30024 |
| Name | Role | Address |
|---|---|---|
| DESAI UDAYKUMAR J | Chief Executive Officer | 2038 AUTUMN VIEW DRIVE, ORLANDO, FL, 32825 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000060192 | MEDOZ PHARMACY | EXPIRED | 2013-06-15 | 2018-12-31 | No data | 2038 AUTUMN VIEW DR, 2038 AUTUMN VIEW DR, ORLANDO, FL, 32825 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-27 | 720 WEST OAK STREET, 114, KISSIMMEE, FL 34741 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-04-27 | Desai, Udaykumar | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-27 | 2038 Autumn View Dr, Orlando, FL 32825 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-05-01 | 720 WEST OAK STREET, 114, KISSIMMEE, FL 34741 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-03-31 |
| ANNUAL REPORT | 2013-04-27 |
| ANNUAL REPORT | 2012-05-01 |
| ANNUAL REPORT | 2011-04-11 |
| ANNUAL REPORT | 2010-02-17 |
| Domestic Profit | 2009-11-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
