| Entity Name: | DOCTOR DIABETIC PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 03 May 2010 (15 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | P10000037880 |
| Address: | 100 N.E. 28TH ST., MIAMI, FL, 33137 |
| Mail Address: | 100 N.E. 28TH ST., MIAMI, FL, 33137 |
| ZIP code: | 33137 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659687119 | 2010-08-23 | 2010-09-03 | 100 NE 28TH STREET, MIAMI, FL, 33137, US | 100 NE 28TH ST, MIAMI, FL, 331374423, US | |||||||||||||||||||||||
|
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| Phone | +1 888-829-7581 |
| Fax | 8669895899 |
Authorized person
| Name | CLAYTON EDWARDS |
| Role | SR. VP PHARMACY OPERATION |
| Phone | 8888297581 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH24828 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 5701417 |
| Name | Role | Address |
|---|---|---|
| PRESTIN BRUCE E | Agent | 2717 W CYPRESS CREEK ROAD, FORT LAUDERDALE, FL, 33309 |
| Name | Role | Address |
|---|---|---|
| HEISEL GEORGE J | President | 8 FARREY LANE, MIAMI BEACH, FL, 33139 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-06-16 | 100 N.E. 28TH ST., MIAMI, FL 33137 | No data |
| CHANGE OF MAILING ADDRESS | 2010-06-16 | 100 N.E. 28TH ST., MIAMI, FL 33137 | No data |
| Name | Date |
|---|---|
| ADDRESS CHANGE | 2010-06-16 |
| Domestic Profit | 2010-05-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
