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  5. EXPRESS MEDICAL & NUTRITION SUPPLY, INC.

EXPRESS MEDICAL & NUTRITION SUPPLY, INC.

Company Details

Entity Name: EXPRESS MEDICAL & NUTRITION SUPPLY, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 06 Feb 1995 (30 years ago)
Document Number: P95000011064
FEI/EIN Number 59-3294108
Address: 6306 BENJAMIN RD., #611, TAMPA, FL 33634
Mail Address: 6306 BENJAMIN RD., SUITE 611, TAMPA, FL 33634
ZIP code: 33634
County: Hillsborough
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1891722898 2006-06-26 2020-08-22 6201 JOHNS RD, SUITE 4, TAMPA, FL, 33534, US 6201 JOHNS RD, SUITE 4, TAMPA, FL, 336344434, US

Contacts
Phone +1 813-885-3444
Fax 8138851729

Authorized person
Name MR. JACK PICKENS
Role OWNER
Phone 8138853444

Taxonomy
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
License Number 3980120428317
State FL
Is Primary No
Taxonomy Code 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME)
License Number 3980120428317
State FL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EXPRESS MEDICAL 401(K) PLAN 2013 593294108 2014-01-15 EXPRESS MEDICAL & NUTRITION SUPPLY 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 423990
Sponsor’s telephone number 8138853444
Plan sponsor’s address 6306 BENJAMIN ROAD, SUITE 606, TAMPA, FL, 336345168

Signature of
Role Plan administrator
Date 2014-01-15
Name of individual signing JACK PICKENS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-01-15
Name of individual signing JACK PICKENS
Valid signature Filed with authorized/valid electronic signature
EXPRESS MEDICAL 401(K) PLAN 2012 593294108 2013-05-15 EXPRESS MEDICAL & NUTRITION SUPPLY 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 423990
Sponsor’s telephone number 8138853444
Plan sponsor’s address 6306 BENJAMIN ROAD, SUITE 606, TAMPA, FL, 336345168

Signature of
Role Plan administrator
Date 2013-05-15
Name of individual signing CHRISTINE C PICKENS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-15
Name of individual signing CHRISTINE C PICKENS
Valid signature Filed with authorized/valid electronic signature
EXPRESS MEDICAL 401(K) PLAN 2011 593294108 2013-05-13 EXPRESS MEDICAL & NUTRITION SUPPLY 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 423990
Sponsor’s telephone number 8138853444
Plan sponsor’s address 6306 BENJAMIN ROAD, SUITE 606, TAMPA, FL, 336345168

Plan administrator’s name and address
Administrator’s EIN 593294108
Plan administrator’s name EXPRESS MEDICAL & NUTRITION SUPPLY
Plan administrator’s address 6306 BENJAMIN ROAD, SUITE 606, TAMPA, FL, 336345168
Administrator’s telephone number 8138853444

Signature of
Role Plan administrator
Date 2013-05-13
Name of individual signing CHRISTINE C PICKENS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-13
Name of individual signing CHRISTINE C PICKENS
Valid signature Filed with authorized/valid electronic signature
EXPRESS MEDICAL 401(K) PLAN 2010 593294108 2012-05-15 EXPRESS MEDICAL & NUTRITION SUPPLY 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 423990
Sponsor’s telephone number 8138853444
Plan sponsor’s address 6306 BENJAMIN ROAD, SUITE 606, TAMPA, FL, 336345168

Plan administrator’s name and address
Administrator’s EIN 593294108
Plan administrator’s name EXPRESS MEDICAL & NUTRITION SUPPLY
Plan administrator’s address 6306 BENJAMIN ROAD, SUITE 606, TAMPA, FL, 336345168
Administrator’s telephone number 8138853444

Signature of
Role Plan administrator
Date 2012-05-15
Name of individual signing JACK PICKENS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-05-15
Name of individual signing JACK PICKENS
Valid signature Filed with authorized/valid electronic signature
EXPRESS MEDICAL 401(K) PLAN 2009 593294108 2012-05-15 EXPRESS MEDICAL & NUTRITION SUPPLY 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2002-01-01
Business code 423990
Sponsor’s telephone number 8138853444
Plan sponsor’s address 6306 BENJAMIN ROAD, SUITE 606, TAMPA, FL, 336345168

Plan administrator’s name and address
Administrator’s EIN 593294108
Plan administrator’s name EXPRESS MEDICAL & NUTRITION SUPPLY
Plan administrator’s address 6306 BENJAMIN ROAD, SUITE 606, TAMPA, FL, 336345168
Administrator’s telephone number 8138853444

Signature of
Role Plan administrator
Date 2012-05-15
Name of individual signing JACK PICKENS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-05-15
Name of individual signing JACK PICKENS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DRUMMOND, TEMPLE H. Agent 6987 EAST FOWLER AVENUE, TAMPA, FL 33617

President

Name Role Address
PICKENS, JACK President 6306 BENJAMIN ROAD SUITE 611, TAMPA, FL 33634

Director

Name Role Address
PICKENS, JACK Director 6306 BENJAMIN ROAD SUITE 611, TAMPA, FL 33634

Vice President

Name Role Address
Corsini, CHRISTINE Vice President 6306 BENJAMIN ROAD, #611 TAMPA, FL 33534

Treasurer

Name Role Address
Corsini, CHRISTINE Treasurer 6306 BENJAMIN ROAD, #611 TAMPA, FL 33534

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2021-03-02 6306 BENJAMIN RD., #611, TAMPA, FL 33634 No data
CHANGE OF PRINCIPAL ADDRESS 2020-09-12 6306 BENJAMIN RD., #611, TAMPA, FL 33634 No data
REGISTERED AGENT NAME CHANGED 2014-04-15 DRUMMOND, TEMPLE H. No data
REGISTERED AGENT ADDRESS CHANGED 2014-04-15 6987 EAST FOWLER AVENUE, TAMPA, FL 33617 No data

Documents

Name Date
ANNUAL REPORT 2024-02-20
ANNUAL REPORT 2023-01-24
ANNUAL REPORT 2022-01-28
ANNUAL REPORT 2021-03-02
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-01-10
ANNUAL REPORT 2018-04-11
ANNUAL REPORT 2017-04-11
ANNUAL REPORT 2016-04-19
ANNUAL REPORT 2015-04-30

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5386657202 2020-04-27 0455 PPP 6306 Benjamin Road Suite 606, TAMPA, FL, 33634-5168
Loan Status Date 2021-02-16
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 45211
Loan Approval Amount (current) 45211
Undisbursed Amount 0
Franchise Name -
Lender Location ID 17715
Servicing Lender Name The Bank of Tampa
Servicing Lender Address 601 Bayshore Blvd, TAMPA, FL, 33606-2747
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address TAMPA, HILLSBOROUGH, FL, 33634-5168
Project Congressional District FL-14
Number of Employees 5
NAICS code 423450
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Subchapter S Corporation
Originating Lender ID 17715
Originating Lender Name The Bank of Tampa
Originating Lender Address TAMPA, FL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 45521.9
Forgiveness Paid Date 2021-01-08

Related by officers

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Date of last update: 02 Feb 2025

Sources: Florida Department of State

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