| Entity Name: | EAGLE LAKE PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
EAGLE LAKE PHARMACY, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 07 Mar 2011 (14 years ago) |
| Date of dissolution: | 27 Sep 2019 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (6 years ago) |
| Document Number: | P11000023050 |
| FEI/EIN Number |
275477007
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 5245 US HWY 98, LAKELAND, FL, 33809, US |
| Mail Address: | 5245 US HWY 98, LAKELAND, FL, 33809, US |
| ZIP code: | 33809 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023374063 | 2012-04-04 | 2016-11-23 | 5245 A U S HWY 98 N, SUITE A, LAKELAND, FL, 33809, US | 5245 A U S HWY 98 N, SUITE A, LAKELAND, FL, 33809, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 863-937-7992 |
| Fax | 8639377994 |
Authorized person
| Name | POLYCARP AGBARA |
| Role | OWNER |
| Phone | 8637388002 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH25608 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004712900 |
| State | FL |
| Issuer | PK |
| Number | 2134900 |
| Name | Role | Address |
|---|---|---|
| Luna Ken | Director | P.O. Box 56192, Houston, TX, 77256 |
| Blanchard Ted | Agent | 5245 US HWY 98 N STE A, LAKELAND, FL, 33809 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000028622 | EAGLE LAKE PHARMACY | EXPIRED | 2011-03-21 | 2016-12-31 | - | P O BOX 1467, HIGHLAND CITY, FL, 33846 |
| G11000028623 | EAGLE LAKE RX | EXPIRED | 2011-03-21 | 2016-12-31 | - | P O BOX 1467, HIGHLAND CITY, FL, 33846 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | - | - |
| REGISTERED AGENT NAME CHANGED | 2018-11-06 | Blanchard, Ted | - |
| REINSTATEMENT | 2018-11-06 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | - | - |
| AMENDMENT | 2018-04-04 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-29 | 5245 US HWY 98 N STE A, LAKELAND, FL 33809 | - |
| AMENDMENT | 2018-03-29 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-21 | 5245 US HWY 98, STE A, LAKELAND, FL 33809 | - |
| CHANGE OF MAILING ADDRESS | 2016-04-21 | 5245 US HWY 98, STE A, LAKELAND, FL 33809 | - |
| Name | Date |
|---|---|
| REINSTATEMENT | 2018-11-06 |
| Amendment | 2018-04-04 |
| Amendment | 2018-03-29 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-01-20 |
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-29 |
| ANNUAL REPORT | 2012-01-26 |
| Domestic Profit | 2011-03-07 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
