| Entity Name: | HEALTHNET PHARMACY SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Apr 1998 (27 years ago) |
| Document Number: | P98000038482 |
| FEI/EIN Number | 650842465 |
| Mail Address: | 3006 AVIATION AVE, COCONUT GROVE, FL, 33133, US |
| Address: | 15518 NW 77 COURT, MIAMI LAKES, FL, 33016, US |
| ZIP code: | 33016 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275579815 | 2006-06-21 | 2019-10-14 | 15518 NW 77TH CT, ROYAL OAKS PLAZA, MIAMI LAKES, FL, 330165804, US | 15518 NW 77TH CT, MIAMI LAKES, FL, 330165804, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 305-823-3461 |
| Fax | 3055576945 |
Authorized person
| Name | MIGUEL MORENO |
| Role | OWNER PHARMACIST |
| Phone | 3058233461 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH16507 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021851100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MORENO MIGUEL | Agent | 15518 NW 77 COURT, MIAMI LAKES, FL, 33016 |
| Name | Role | Address |
|---|---|---|
| MORENO MIGUEL A | Director | 15518 NW 77 COURT, MIAMI LAKES, FL, 33016 |
| MORENO NORMA | Director | 15518 NW 77 COURT, MIAMI LAKES, FL, 33016 |
| Name | Role | Address |
|---|---|---|
| MORENO MIGUEL A | President | 15518 NW 77 COURT, MIAMI LAKES, FL, 33016 |
| Name | Role | Address |
|---|---|---|
| PERAZA NIURIS | Secretary | 15518 NW 77 COURT, MIAMI LAKES, FL, 33016 |
| Name | Role | Address |
|---|---|---|
| GARCIA YVONE | Vice President | 15518 NW 77 COURT, MIAMI LAKES, FL, 33016 |
| Name | Role | Address |
|---|---|---|
| MORENO NORMA | Treasurer | 15518 NW 77 COURT, MIAMI LAKES, FL, 33016 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000000639 | MY CARE PHARMACY | ACTIVE | 2016-01-04 | 2026-12-31 | No data | 15518 NW 77 CT, MIAMI LAKES, FL, 33016 |
| G09000158335 | MORENO PHARMACY | EXPIRED | 2009-09-23 | 2014-12-31 | No data | 1550 WEST 84 AVENUE, HIALEAH, FL, 33014 |
| G99064900118 | UNIVERSAL ARTS PHARMACY | ACTIVE | 1999-03-05 | 2029-12-31 | No data | 15518 NW 77TH CT, MIAMI LAKES, FL, 33016 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 1999-10-15 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
