| Entity Name: | COUNTRY CLUB PHARMACY & DISCOUNT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 13 Aug 2010 (14 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P10000066968 |
| FEI/EIN Number | 273719988 |
| Address: | 5911 NW 173RD DRIVE, # 6, MIAMI, FL, 33015 |
| Mail Address: | 5911 NW 173RD DRIVE, # 6, MIAMI, FL, 33015 |
| ZIP code: | 33015 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447691555 | 2013-07-17 | 2013-07-17 | 5911 NW 173RD DR, # 6, HIALEAH, FL, 330155121, US | 5911 NW 173RD DR, # 6, HIALEAH, FL, 330155121, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-828-8600 |
| Fax | 3058288630 |
Authorized person
| Name | DAISY MARTINEZ |
| Role | PRESIDENT |
| Phone | 3058288600 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH26903 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NUMB |
| Number | 3719 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARTINEZ DAISY | Agent | 5911 NW 173RD DRIVE, MIAMI, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ DAISY | President | 5911 NW 173 DR #6, MIAMI, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ DAISY | Director | 5911 NW 173 DR #6, MIAMI, FL, 33015 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REINSTATEMENT | 2013-12-06 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-09-20 | 5911 NW 173RD DRIVE, # 6, MIAMI, FL 33015 | No data |
| CHANGE OF MAILING ADDRESS | 2011-09-20 | 5911 NW 173RD DRIVE, # 6, MIAMI, FL 33015 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-09-20 | 5911 NW 173RD DRIVE, #6, MIAMI, FL 33015 | No data |
| AMENDMENT AND NAME CHANGE | 2010-10-13 | COUNTRY CLUB PHARMACY & DISCOUNT, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2012-04-27 |
| ANNUAL REPORT | 2011-09-20 |
| Amendment and Name Change | 2010-10-13 |
| Domestic Profit | 2010-08-13 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
