| Entity Name: | ST LUKE PHARMACY, CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 31 Aug 2010 (14 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P10000071656 |
| FEI/EIN Number | 27-3449154 |
| Address: | 2019 GULF TO BAY BLVD, CLEARWATER, FL 33765 |
| Mail Address: | 2019 GULF TO BAY BLVD, CLEARWATER, FL 33765 |
| ZIP code: | 33765 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831458868 | 2012-05-11 | 2015-07-13 | 2019 GULF TO BAY BLVD, CLEARWATER, FL, 337653703, US | 2019 GULF TO BAY BLVD, CLEARWATER, FL, 337653703, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 727-754-7851 |
| Fax | 7277547852 |
Authorized person
| Name | JOHN MUSALLAM |
| Role | PRESIDENT |
| Phone | 7277547851 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH25416 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008099500 |
| State | FL |
| Issuer | PK |
| Number | 2135137 |
| Name | Role | Address |
|---|---|---|
| MUSALLAM, JOHN | Agent | 2019 GULF TO BAY BLVD, CLEARWATER, FL 33765 |
| Name | Role | Address |
|---|---|---|
| MUSALLAM, JOHN | President | 6110 COLMAR PL, APOLLO BEACH, FL 33572 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-11-24 | 2019 GULF TO BAY BLVD, CLEARWATER, FL 33765 | No data |
| AMENDMENT | 2015-11-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-10-01 | MUSALLAM, JOHN | No data |
| REINSTATEMENT | 2015-10-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REINSTATEMENT | 2011-11-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-02-14 | 2019 GULF TO BAY BLVD, CLEARWATER, FL 33765 | No data |
| CHANGE OF MAILING ADDRESS | 2011-02-14 | 2019 GULF TO BAY BLVD, CLEARWATER, FL 33765 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-30 |
| ANNUAL REPORT | 2016-04-30 |
| Amendment | 2015-11-24 |
| REINSTATEMENT | 2015-10-01 |
| ANNUAL REPORT | 2014-02-13 |
| ANNUAL REPORT | 2013-02-19 |
| ANNUAL REPORT | 2012-02-02 |
| REINSTATEMENT | 2011-11-22 |
| ADDRESS CHANGE | 2011-02-14 |
| Domestic Profit | 2010-08-31 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
