| Entity Name: | RX EXPRESS PHARMACY OF MILTON, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 13 Dec 2011 (13 years ago) |
| Document Number: | P11000105536 |
| FEI/EIN Number | 454025708 |
| Address: | 5987 Berryhill Road, Milton, FL, 32570, US |
| Mail Address: | PO BOX 3706, Milton, FL, 32572, US |
| ZIP code: | 32570 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619240942 | 2012-02-16 | 2014-10-23 | 5987 BERRYHILL RD, MILTON, FL, 325704043, US | 5987 BERRYHILL RD, MILTON, FL, 325704043, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-623-6337 |
| Fax | 8506236339 |
Authorized person
| Name | MATTHEW WALTERS |
| Role | PRESIDENT/PHARMACY MANAGER |
| Phone | 8506376844 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH25939 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3336C0004X - Compounding Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2133981 |
| Issuer | MEDICAID |
| Number | 004633600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WALTERS MATTHEW C | Agent | 4004 EBENEZER CHURCH ROAD, JAY, FL, 32565 |
| Name | Role | Address |
|---|---|---|
| WALTERS MATTHEW C | President | 4004 EBENEZER CHURCH ROAD, JAY, FL, 32565 |
| Name | Role | Address |
|---|---|---|
| WALTERS MATTHEW C | Director | 4004 EBENEZER CHURCH ROAD, JAY, FL, 32565 |
| HOLSTON STEPHEN S | Director | 2510 MUIR WOODS DRIVE W, MOBILE, AL, 36693 |
| MCMELLON PAUL A | Director | 6291 CALLE DE HIDALIGO, NAVARRE, FL, 32566 |
| MCMELLON STEVEN A | Director | 19001 GOFF FARM ROAD, MOSS POINT, MS, 39562 |
| Name | Role | Address |
|---|---|---|
| HOLSTON STEPHEN S | Vice President | 2510 MUIR WOODS DRIVE W, MOBILE, AL, 36693 |
| Name | Role | Address |
|---|---|---|
| MCMELLON PAUL A | Secretary | 6291 CALLE DE HIDALIGO, NAVARRE, FL, 32566 |
| Name | Role | Address |
|---|---|---|
| MCMELLON PAUL A | Treasurer | 6291 CALLE DE HIDALIGO, NAVARRE, FL, 32566 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-13 | 5987 Berryhill Road, Milton, FL 32570 | No data |
| CHANGE OF MAILING ADDRESS | 2013-02-19 | 5987 Berryhill Road, Milton, FL 32570 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-03-04 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-02-09 |
| ANNUAL REPORT | 2015-02-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
