| Entity Name: | CORKREANS THE PHARMACIST, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Dec 2016 (8 years ago) |
| Document Number: | P16000100912 |
| FEI/EIN Number | 81-4817860 |
| Address: | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788, US |
| Mail Address: | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788, US |
| ZIP code: | 34788 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538101167 | 2006-06-11 | 2020-07-20 | 32713 COUNTY ROAD 473, LEESBURG, FL, 347888856, US | 32713 COUNTY ROAD 473, LEESBURG, FL, 347888856, US | |||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 352-742-8080 |
| Fax | 3527429292 |
Authorized person
| Name | MR. JAMES ALAN CORKREAN |
| Role | PHARMACIST/OWNER |
| Phone | 3527428080 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101248700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 101248701 |
| State | FL |
| Issuer | NABP |
| Number | 1067277 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CORKREAN JAMES A | Agent | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| Name | Role | Address |
|---|---|---|
| CORKREAN JAMES A | Secretary | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| Name | Role | Address |
|---|---|---|
| CORKREAN JAMES A | Treasurer | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| Name | Role | Address |
|---|---|---|
| CORKREAN JAMES A | Director | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| Name | Role | Address |
|---|---|---|
| CORKREAN SEAN P | Vice President | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| Name | Role | Address |
|---|---|---|
| CORKREAN BELINDA J | ASAT | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| Name | Role | Address |
|---|---|---|
| CORKREAN JAMES A | President | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000090754 | THE PHARMACIST | ACTIVE | 2020-07-28 | 2025-12-31 | No data | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| G20000005480 | THE CORKREAN CLINIC FOR HEALTH AND WELLNESS | ACTIVE | 2020-01-13 | 2025-12-31 | No data | 32713 COUNTY ROAD 473, LEESBURG, FL, 34788 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-05 | 32713 COUNTY ROAD 473, LEESBURG, FL 34788 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-05 | 32713 COUNTY ROAD 473, LEESBURG, FL 34788 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-05 | 32713 COUNTY ROAD 473, LEESBURG, FL 34788 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-01-06 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-02-14 |
| Domestic Profit | 2016-12-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
