| Entity Name: | RAGHAVENDRA PHARMACY INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 02 Mar 2010 (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: | P10000018812 |
| FEI/EIN Number | 272062960 |
| Address: | 5431 NORTH STATE ROAD # 7, TAMARAC, FL, 34786 |
| Mail Address: | 5431 NORTH STATE ROAD # 7, TAMARAC, FL, 34786 |
| ZIP code: | 34786 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164734927 | 2010-07-09 | 2010-07-09 | 5431 N STATE ROAD 7, TAMARAC, FL, 333192921, US | 5431 N STATE ROAD 7, TAMARAC, FL, 333192921, US | |||||||||||||||||||||||||||
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| Phone | +1 954-485-4903 |
| Fax | 9544854948 |
Authorized person
| Name | NAGESH SHAKHAMOORI |
| Role | VICE PRESIDENT |
| Phone | 2486316612 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24727 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5700605 |
| Name | Role | Address |
|---|---|---|
| kondapalli siva | Agent | 6970 SWINSCOE LN, WINDEREMERE, FL, 34786 |
| Name | Role | Address |
|---|---|---|
| KONDAPALLI SHIVA | President | 1433 CARING CT, MAITLAND, FL, 32751 |
| Name | Role | Address |
|---|---|---|
| kolla ajay | memb | 5431 NORTH STATE ROAD # 7, TAMARAC, FL, 34786 |
| shakhamoori nagesh | memb | 5431 NORTH STATE ROAD # 7, TAMARAC, FL, 34786 |
| pinnamaneni syam | memb | 5431 NORTH STATE ROAD # 7, TAMARAC, FL, 34786 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000021799 | LAKESIDE DISCOUNT PHARMACY | EXPIRED | 2010-03-08 | 2015-12-31 | No data | 6970 SWINCOE LN, WINDERMERE, FL, 34786 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-22 | kondapalli, siva | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-02-09 | 5431 NORTH STATE ROAD # 7, TAMARAC, FL 34786 | No data |
| CHANGE OF MAILING ADDRESS | 2011-02-09 | 5431 NORTH STATE ROAD # 7, TAMARAC, FL 34786 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-02-09 | 6970 SWINSCOE LN, WINDEREMERE, FL 34786 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-02-26 |
| ANNUAL REPORT | 2013-01-22 |
| ANNUAL REPORT | 2012-03-05 |
| ANNUAL REPORT | 2011-02-09 |
| Domestic Profit | 2010-03-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
