| Entity Name: | PROXYCARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 13 Apr 1994 (31 years ago) |
| Document Number: | P94000028076 |
| FEI/EIN Number | 65-0481978 |
| Address: | 747 SHOTGUN RD, SUNRISE, FL 33326 |
| Mail Address: | 747 SHOTGUN RD, SUNRISE, FL 33326 |
| ZIP code: | 33326 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932145497 | 2006-06-22 | 2019-09-09 | 747 SHOTGUN ROAD, SUNRISE, FL, 333261934, US | 747 SHOTGUN ROAD, SUNRISE, FL, 333261934, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 954-791-5400 |
| Fax | 9547915100 |
Authorized person
| Name | MR. LUIS ALBERTO CRUZ |
| Role | CEO |
| Phone | 9547915400 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH12946 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022228300 |
| State | FL |
| Issuer | PK |
| Number | 2011819 |
| Name | Role | Address |
|---|---|---|
| KLEIN, TED ESQ. | Agent | 8030 PETERS ROAD, BUILDING D SUITE 104, PLANTATION, FL 33324 |
| Name | Role | Address |
|---|---|---|
| CRUZ, LUIS A | Chief Executive Officer | 747 SHOTGUN RD, SUNRISE, FL 33326 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2019-01-11 | 747 SHOTGUN RD, SUNRISE, FL 33326 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-05-02 | 747 SHOTGUN RD, SUNRISE, FL 33326 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-01-05 | 8030 PETERS ROAD, BUILDING D SUITE 104, PLANTATION, FL 33324 | No data |
| REGISTERED AGENT NAME CHANGED | 2000-04-10 | KLEIN, TED ESQ. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-01-04 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-01-09 |
| ANNUAL REPORT | 2020-01-03 |
| ANNUAL REPORT | 2019-01-11 |
| ANNUAL REPORT | 2018-01-04 |
| ANNUAL REPORT | 2017-01-05 |
| ANNUAL REPORT | 2016-01-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
