| Entity Name: | FAMILY PHARMACY & MEDICAL SUPPLY, CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 15 Jan 2015 (10 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 28 Oct 2020 (4 years ago) |
| Document Number: | P15000005041 |
| FEI/EIN Number | 47-3182306 |
| Address: | 9861 BERNWOOD PLACE DR, Ste 145, FORT MYERS, FL 33966 |
| Mail Address: | 9861 BERNWOOD PLACE DR, Ste 145, FORT MYERS, FL 33966 |
| ZIP code: | 33966 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972973055 | 2015-10-01 | 2021-01-24 | 9861 BERNWOOD PLACE DR STE 145, FORT MYERS, FL, 339666545, US | 9861 BERNWOOD PLACE DR STE 145, FORT MYERS, FL, 339666545, US | |||||||||||||||||||||
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| Phone | +1 239-288-6997 |
| Fax | 2392886497 |
Authorized person
| Name | MR. FALGUN B PATEL |
| Role | MANAGER |
| Phone | 2392886997 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016655600 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FAMILY PHARMACY & MEDICAL SUPPLY CORP | 2023 | 473182306 | 2024-10-04 | FAMILY PHARMACY & MEDICAL SUPPLY | 1 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-04 |
| Name of individual signing | FALGUN PATEL |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| GUPTA, DEEPAK | Agent | 10350 Meadowrun Dr, Lithia, FL 33547 |
| Name | Role | Address |
|---|---|---|
| PATEL, FALGUN B | President | 1235 CARRIAGE PARK DRIVE, VALRICO, FL 33594 |
| Name | Role | Address |
|---|---|---|
| PATEL, FALGUN B | T.D | 1235 CARRIAGE PARK DRIVE, VALRICO, FL 33594 |
| Name | Role | Address |
|---|---|---|
| GUPTA, DEEPAK | Vice President | 10350 Meadowrun Dr, Lithia, FL 33547 |
| Name | Role | Address |
|---|---|---|
| GUPTA, DEEPAK | Secretary | 10350 Meadowrun Dr, Lithia, FL 33547 |
| Name | Role | Address |
|---|---|---|
| GUPTA, DEEPAK | Director | 10350 Meadowrun Dr, Lithia, FL 33547 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-23 | 9861 BERNWOOD PLACE DR, Ste 145, FORT MYERS, FL 33966 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-23 | 9861 BERNWOOD PLACE DR, Ste 145, FORT MYERS, FL 33966 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-23 | 10350 Meadowrun Dr, Lithia, FL 33547 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-14 | GUPTA, DEEPAK | No data |
| AMENDMENT | 2020-10-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-23 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-03-22 |
| Amendment | 2020-10-28 |
| ANNUAL REPORT | 2020-06-22 |
| ANNUAL REPORT | 2019-04-28 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-31 |
| ANNUAL REPORT | 2016-04-26 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
