| Entity Name: | QUALITY SPECIALTY PHARMACY OF JACKSONVILLE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Feb 2011 (14 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P11000018725 |
| FEI/EIN Number | 800687983 |
| Address: | 6680 POWERS AVE #110, JACKSONVILLE, FL, 32217, US |
| Mail Address: | P.O. BOX 16159, TEMPLE TERRACE, FL, 33687-6159, US |
| ZIP code: | 32217 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457630519 | 2011-08-08 | 2016-10-26 | P.O. BOX 16159, TEMPLE TERRACE, FL, 33682, US | 6680 POWERS AVE, UNIT 110, JACKSONVILLE, FL, 322172889, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-365-5500 |
| Fax | 9043655501 |
Authorized person
| Name | SOFIA AXEN |
| Role | OWNER |
| Phone | 7186482952 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH25472 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336S0011X - Specialty Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004444200 |
| State | FL |
| Issuer | PK |
| Number | 2131100 |
| Name | Role | Address |
|---|---|---|
| AXEN SOFIA | Agent | 18023 Java Isle Dr, TAMPA, FL, 33647 |
| Name | Role | Address |
|---|---|---|
| Sofia Axen, as Trustee of the Revocable Li | Authorized Member | 18023 Java Isle Dr, TAMPA, FL, 33647 |
| Vadim Pinhasov, as Trustee of the Revocabl | Authorized Member | 10605 Cayman Isle Ct, TAMPA, FL, 33647 |
| BABENKO EUGENE | Authorized Member | 125 S Clark Ave, Tampa, FL, 33609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-01-16 | 18023 Java Isle Dr, TAMPA, FL 33647 | No data |
| AMENDMENT | 2014-05-09 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-05-09 | 6680 POWERS AVE #110, JACKSONVILLE, FL 32217 | No data |
| CHANGE OF MAILING ADDRESS | 2014-05-09 | 6680 POWERS AVE #110, JACKSONVILLE, FL 32217 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-02-24 |
| ANNUAL REPORT | 2018-01-31 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-16 |
| ANNUAL REPORT | 2015-02-20 |
| Amendment | 2014-05-09 |
| ANNUAL REPORT | 2014-01-22 |
| ANNUAL REPORT | 2013-03-26 |
| ANNUAL REPORT | 2012-04-17 |
| Domestic Profit | 2011-02-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
