| Entity Name: | PHARMACY AT ABACOA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 03 Jan 2017 (8 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 13 Feb 2017 (8 years ago) |
| Document Number: | P17000000660 |
| FEI/EIN Number | 81-4813388 |
| Address: | 1155 MAIN STREET, UNIT 109, JUPITER, FL, 33458, US |
| Mail Address: | PO BOX 912, JUPITER, FL, 33468, US |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093222622 | 2018-01-04 | 2021-11-17 | PO BOX 912, JUPITER, FL, 33468, US | 1155 MAIN ST, UNIT 109, JUPITER, FL, 334585263, US | |||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||
| Phone | +1 855-349-6800 |
| Fax | 5616303771 |
| Phone | +1 561-630-3770 |
Authorized person
| Name | DANIEL SPIVAK |
| Role | CEO |
| Phone | 5616303770 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH30819 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2175233 |
| Issuer | MEDICAID |
| Number | 022716900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SPIVAK PAUL | Agent | 148 OAKWOOD LANE, PALM BEACH GARDENS, FL, 33410 |
| Name | Role | Address |
|---|---|---|
| SPIVAK DANIEL | Chief Executive Officer | 150 OAKWOOD LN, PALM BEACH GARDENS, FL, 33410 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2017-02-13 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-02-11 |
| AMENDED ANNUAL REPORT | 2021-02-24 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-20 |
| AMENDED ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2019-02-26 |
| ANNUAL REPORT | 2018-01-15 |
| Amendment | 2017-02-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
