| Entity Name: | NORTH FORT MYERS PRESCRIPTION SHOP, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 09 Dec 2011 (13 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | P11000105219 |
| FEI/EIN Number | 453693212 |
| Address: | 16251 NORTH CLEVELAND AVE STE. 13, N. FT. MYERS, FL, 33903, US |
| Mail Address: | 16251 NORTH CLEVELAND AVE STE. 13, N. FT. MYERS, FL, 33903, US |
| ZIP code: | 33903 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700159498 | 2012-02-11 | 2017-02-16 | 16251 N CLEVELAND AVE, SUITE 13, NORTH FORT MYERS, FL, 339032176, US | 16251 N CLEVELAND AVE, SUITE 13, NORTH FORT MYERS, FL, 339032176, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 239-599-4120 |
| Fax | 2395994122 |
Authorized person
| Name | LISA LAWRENCE |
| Role | OWNER/PHARMACIST IN CHARGE |
| Phone | 2395994120 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH25927 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2133999 |
| Issuer | MEDICAID |
| Number | 004617200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAWRENCE LISA | Agent | 9085 Astonia Way, Estero, FL, 33967 |
| Name | Role | Address |
|---|---|---|
| LAWRENCE LISA | President | 9085 ASTONIA WAY, ESTERO, FL, 33967 |
| Name | Role | Address |
|---|---|---|
| LAWRENCE RICH | Vice President | 9085 ASTONIA WAY, ESTERO, FL, 33967 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-01-11 | 9085 Astonia Way, Estero, FL 33967 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-02-29 | 16251 NORTH CLEVELAND AVE STE. 13, N. FT. MYERS, FL 33903 | No data |
| CHANGE OF MAILING ADDRESS | 2012-02-29 | 16251 NORTH CLEVELAND AVE STE. 13, N. FT. MYERS, FL 33903 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-02-13 |
| ANNUAL REPORT | 2019-01-30 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-28 |
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-01-20 |
| ANNUAL REPORT | 2013-01-30 |
| ANNUAL REPORT | 2012-02-29 |
| Domestic Profit | 2011-12-09 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
