| Entity Name: | PHARMA SOURCE - DME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Nov 1999 (25 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 27 Sep 2005 (19 years ago) |
| Document Number: | P99000100599 |
| FEI/EIN Number | 650964827 |
| Address: | 14025 WEST DIXIE HWY, NORTH MIAMI, FL, 33161 |
| Mail Address: | 14025 WEST DIXIE HWY, NORTH MIAMI, FL, 33161 |
| ZIP code: | 33161 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548471923 | 2007-05-25 | 2008-09-17 | 14045 W DIXIE HWY, NORTH MIAMI, FL, 331613442, US | 14045 W DIXIE HWY, NORTH MIAMI, FL, 331613442, US | |||||||||||||||||||||||||
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| Phone | +1 305-899-0943 |
| Fax | 3058990945 |
Authorized person
| Name | MRS. ESTELA PINNAVARIA |
| Role | PHARMACIST |
| Phone | 3058990943 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH17703 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022952100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PINNAVARIA ESTELA | Agent | 14025 WEST DIXIE HWY, NORTH MIAMI, FL, 33161 |
| Name | Role | Address |
|---|---|---|
| PINNAVARIA ESTELA | President | 14025 WEST DIXIE HWY, NORTH MIAMI, FL, 33161 |
| Name | Role | Address |
|---|---|---|
| PINNAVARIA ESTELA | Director | 14025 WEST DIXIE HWY, NORTH MIAMI, FL, 33161 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2011-02-21 | 14025 WEST DIXIE HWY, NORTH MIAMI, FL 33161 | No data |
| CHANGE OF MAILING ADDRESS | 2011-02-21 | 14025 WEST DIXIE HWY, NORTH MIAMI, FL 33161 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-02-21 | 14025 WEST DIXIE HWY, NORTH MIAMI, FL 33161 | No data |
| CANCEL ADM DISS/REV | 2005-09-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-15 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-03-20 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-03-03 |
| ANNUAL REPORT | 2017-02-21 |
| ANNUAL REPORT | 2016-01-22 |
| ANNUAL REPORT | 2015-06-15 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
