| Entity Name: | GREEN STAR PHARMACY CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 Dec 2019 (5 years ago) |
| Date of dissolution: | 08 Jun 2021 (4 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 08 Jun 2021 (4 years ago) |
| Document Number: | P19000092377 |
| Address: | 2611 30TH STREET SW, LEHIGH ACRES, FL, 33916, US |
| Mail Address: | 2611 30TH STREET SW, LEHIGH ACRES, FL, 33976, US |
| ZIP code: | 33916 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962011890 | 2020-07-27 | 2020-07-27 | 2611 30TH ST SW, LEHIGH ACRES, FL, 339764091, US | 2950 WINKLER AVE STE 701, FORT MYERS, FL, 339169322, US | |||||||||||||||||||||||
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| Phone | +1 239-240-4345 |
| Fax | 2399313605 |
| Phone | +1 239-931-3605 |
Authorized person
| Name | MR. FRUSNEL AUGUSTIN |
| Role | PHARMACY MANAGER/ PHARMACIST |
| Phone | 1239240434 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1396015798 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AUGUSTIN FRUSNEL MR. | Agent | 2611 30TH STREET SW, LEHIGH ACRES, FL, 33976 |
| Name | Role | Address |
|---|---|---|
| AUGUSTIN FRUSNEL MR. | President | 2611 30TH STREET, LEHIGH ACRES, FL, 33976 |
| Name | Role | Address |
|---|---|---|
| AUGUSTIN DANEILLE MRS. | Vice President | 2611 30TH STREET SW, LEHIGH ACRES, FL, 33976 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-06-08 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-25 | 2611 30TH STREET SW, LEHIGH ACRES, FL 33916 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2021-06-08 |
| Domestic Profit | 2019-12-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
