| Entity Name: | BAY DERMATOLOGY & COSMETIC SURGERY, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Dec 1994 (30 years ago) |
| Document Number: | P94000088000 |
| FEI/EIN Number | 593282073 |
| Address: | 8220 U.S. 19 NORTH, PORT RICHEY, FL, 34668, US |
| Mail Address: | 8220 U.S. 19 NORTH, PORT RICHEY, FL, 34668, US |
| ZIP code: | 34668 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740694942 | 2014-06-16 | 2015-05-15 | 4683 CHABOT DR STE 200, C/O ADVANCED RX MANAGEMENT, PLEASANTON, CA, 945883829, US | 7500 GULF BLVD, SUITE B, ST PETE BEACH, FL, 337061821, US | |||||||||||||||||||
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| Phone | +1 925-621-2900 |
| Fax | 9255222930 |
| Phone | +1 727-258-0625 |
| Fax | 7273601680 |
Authorized person
| Name | KATI GAINOUS |
| Role | PHARMACY PROGRAM ADMINISTRATOR |
| Phone | 9256212900 |
Taxonomy
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MILLER RICHARD A | Agent | 8220 US 19 NORTH, PORT RICHEY, FL, 34668 |
| Name | Role | Address |
|---|---|---|
| MILLER RICHARD A | Director | 8220 U.S. 19 NORTH, PORT RICHEY, FL, 34668 |
| KRUTHCHIK MICHAEL E | Director | 8220 U.S. HWY 19 NORTH, PORT RICHEY, FL, 34668 |
| WITFILL KRISTIN | Director | 8220 U.S. HWY 19 NORTH, PORT RICHEY, FL, 34668 |
| DORTON DAVID W | Director | 8220 U.S. HWY 19 NORTH, PORT RICHEY, FL, 34668 |
| ESGUERRA DAVID | Director | 8220 U.S. HWY 19 NORTH, PORT RICHEY, FL, 34668 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000020434 | CENTER FOR MEDICAL REJUVENATION | EXPIRED | 2013-02-27 | 2018-12-31 | No data | 8220 US HWY 19 N., PORT RICHEY, FL, 34668 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 1999-05-07 | BAY DERMATOLOGY & COSMETIC SURGERY, P.A. | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
