| Entity Name: | MY PHARMACY OF BIG BEND, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Aug 2013 (11 years ago) |
| Document Number: | P13000069198 |
| FEI/EIN Number | 46-3252014 |
| Address: | 1028 E Brandon Blvd, Brandon, FL, 33511, US |
| Mail Address: | 1028 E Brandon Blvd, Brandon, FL, 33511, US |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811339336 | 2013-07-25 | 2020-04-17 | 538 WILBUR ST, BRANDON, FL, 335115324, US | 538 WILBUR ST, BRANDON, FL, 335115324, US | |||||||||||||||||||||||||
|
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| Phone | +1 813-699-3496 |
| Fax | 8136995190 |
Authorized person
| Name | MR. MATHEW RYAN GONZALES |
| Role | PRESIDENT |
| Phone | 8136993496 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009863500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALES MATT | Agent | 1028 E Brandon Blvd, Brandon, FL, 33511 |
| Name | Role | Address |
|---|---|---|
| GONZALES MATT | President | 1028 E Brandon Blvd, Brandon, FL, 33511 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000039526 | WESTSIDE PHARMACY | ACTIVE | 2020-04-08 | 2025-12-31 | No data | 538 WILBUR ST, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-05-26 | 1028 E Brandon Blvd, Brandon, FL 33511 | No data |
| CHANGE OF MAILING ADDRESS | 2023-05-26 | 1028 E Brandon Blvd, Brandon, FL 33511 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-05-26 | 1028 E Brandon Blvd, Brandon, FL 33511 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-04-29 | GONZALES, MATT | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J22000092215 | TERMINATED | 1000000914309 | HILLSBOROU | 2022-02-03 | 2032-02-23 | $ 384.47 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236 |
| J22000092207 | TERMINATED | 1000000914308 | HILLSBOROU | 2022-02-03 | 2042-02-23 | $ 3,190.58 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| AMENDED ANNUAL REPORT | 2023-05-26 |
| ANNUAL REPORT | 2023-03-28 |
| ANNUAL REPORT | 2022-05-04 |
| ANNUAL REPORT | 2021-03-17 |
| Reg. Agent Change | 2020-04-29 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-25 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
