| Entity Name: | REVIVE PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
REVIVE 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: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 10 May 2012 (13 years ago) |
| Document Number: | P12000043993 |
| FEI/EIN Number |
45-5246441
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 16205 SOUTH TAMIAMI TRAIL, SUITE 6, FORT MYERS, FL, 33908, US |
| Mail Address: | 16205 SOUTH TAMIAMI TRAIL, SUITE 6, FORT MYERS, FL, 33908, US |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558610527 | 2012-09-05 | 2016-02-26 | 16205 S TAMIAMI TRL, SUITE # 6, FORT MYERS, FL, 339085304, US | 16205 S TAMIAMI TRL, SUITE # 6, FORT MYERS, FL, 339085304, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 239-204-4223 |
| Fax | 2392044224 |
Authorized person
| Name | NICOLE DEFORTE |
| Role | OWNER |
| Phone | 2392044223 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH26342 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2136822 |
| Issuer | MEDICAID |
| Number | 006790300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DEFORTE NICOLE | President | 16205 SOUTH TAMIAMI TRAIL, FORT MYERS, FL, 33908 |
| Deforte Fidel | Fina | 16205 SOUTH TAMIAMI TRAIL, FORT MYERS, FL, 33908 |
| DEFORTE NICOLE | Agent | 16205 SOUTH TAMIAMI TRAIL, FORT MYERS, FL, 33908 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-28 | 16205 SOUTH TAMIAMI TRAIL, SUITE 6, FORT MYERS, FL 33908 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-03-27 |
| ANNUAL REPORT | 2019-02-04 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-03-21 |
| ANNUAL REPORT | 2016-01-22 |
| ANNUAL REPORT | 2015-02-02 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4049447704 | 2020-05-01 | 0455 | PPP | 16205 S TAMIAMI TRAIL UNIT #6, FORT MYERS, FL, 33908 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 May 2025
Sources: Florida Department of State
