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  5. INFUSERVE AMERICA, INC.

INFUSERVE AMERICA, INC.

Headquarter

Company Details

Entity Name: INFUSERVE AMERICA, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 09 Apr 1991 (34 years ago)
Last Event: AMENDMENT
Event Date Filed: 03 Sep 2013 (11 years ago)
Document Number: S43905
FEI/EIN Number 59-3059261
Address: 11880 28TH STREET NORTH, SUITE 200, ST PETERSBURG, FL 33716
Mail Address: 11880 28TH STREET NORTH, SUITE 200, ST PETERSBURG, FL 33716
ZIP code: 33716
County: Pinellas
Place of Formation: FLORIDA

Links between entities

Type Company Name Company Number State
Headquarter of INFUSERVE AMERICA, INC., ALASKA 10106876 ALASKA
Headquarter of INFUSERVE AMERICA, INC., ALABAMA 000-536-095 ALABAMA
Headquarter of INFUSERVE AMERICA, INC., NEW YORK 5590719 NEW YORK

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1386635126 2005-11-01 2012-01-20 11880 28TH ST N, SUITE 200/ 2ND FLOOR, ST PETERSBURG, FL, 337161824, US 11880 28TH ST N, SUITE 200/ 2ND FLOOR, ST PETERSBURG, FL, 337161824, US

Contacts
Phone +1 727-573-7847
Fax 7275730535

Authorized person
Name MR. DAVID WAYNE KAZARIAN
Role PRESIDENT
Phone 7275737847

Taxonomy
Taxonomy Code 333600000X - Pharmacy
License Number PH11528
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
INFUSERVE AMERICA INC 401(K) PROFIT SHARING PLAN AND TRUST 2023 593059261 2024-07-24 INFUSERVE AMERICA, INC 89
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2024-07-24
Name of individual signing TARA EVANS
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401(K) PROFIT SHARING PLAN AND TRUST 2022 593059261 2023-06-23 INFUSERVE AMERICA, INC 81
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2023-06-23
Name of individual signing TARA EVANS
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401(K) PROFIT SHARING PLAN AND TRUST 2021 593059261 2022-07-13 INFUSERVE AMERICA, INC 57
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Plan administrator’s name and address
Administrator’s EIN 621874769
Plan administrator’s name TAG RESOURCES, LLC
Plan administrator’s address 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919
Administrator’s telephone number 8656701844

Signature of
Role Plan administrator
Date 2022-07-13
Name of individual signing TARA EVANS
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401(K) PROFIT SHARING PLAN & TRUST 2020 593059261 2021-11-02 INFUSERVE AMERICA INC 73
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2021-11-02
Name of individual signing RYAN L CORNWELL
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401(K) PROFIT SHARING PLAN & TRUST 2019 593059261 2020-04-09 INFUSERVE AMERICA INC 66
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2020-04-09
Name of individual signing RYAN L CORNWELL
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401 K PROFIT SHARING PLAN TRUST 2018 593059261 2019-03-05 INFUSERVE AMERICA INC 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2019-03-05
Name of individual signing RYAN L CORNWELL
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401 K PROFIT SHARING PLAN TRUST 2017 593059261 2018-05-17 INFUSERVE AMERICA INC 52
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2018-05-17
Name of individual signing RYAN L CORNWELL
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401 K PROFIT SHARING PLAN TRUST 2016 593059261 2017-05-03 INFUSERVE AMERICA INC 37
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2017-05-03
Name of individual signing RYAN L CORNWELL
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401 K PROFIT SHARING PLAN TRUST 2016 593059261 2017-07-07 INFUSERVE AMERICA INC 37
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2017-07-07
Name of individual signing RYAN L CORNWELL
Valid signature Filed with authorized/valid electronic signature
INFUSERVE AMERICA INC 401 K PROFIT SHARING PLAN TRUST 2015 593059261 2016-05-12 INFUSERVE AMERICA INC 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2013-01-01
Business code 541990
Sponsor’s telephone number 7275737847
Plan sponsor’s address 11880 28TH STREET N, SUITE 200, SAINT PETERSBURG, FL, 33716

Signature of
Role Plan administrator
Date 2016-05-12
Name of individual signing RYAN L CORNWELL
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Sargis, Knyazyan Agent 11880 28TH STREET N, SUITE 200, St. Petersburg, FL 33716

Chief Executive Officer

Name Role Address
KAZARIAN, DAVID W Chief Executive Officer 11880 28TH STREET N, SUITE 200, ST. PETERSBURG, FL 33716

Treasurer

Name Role Address
KAZARIAN, DAVID W Treasurer 11880 28TH STREET N, SUITE 200, ST. PETERSBURG, FL 33716
GRISE, JOHN P Treasurer 11880N 28TH STREET N, SUITE 200, ST. PETERSBURG, FL 33716

Director

Name Role Address
KAZARIAN, DAVID W Director 11880 28TH STREET N, SUITE 200, ST. PETERSBURG, FL 33716
GRISE, JOHN P Director 11880N 28TH STREET N, SUITE 200, ST. PETERSBURG, FL 33716
Pytlarz , Alexander Director 11880 28th Street North, St. Petersburgh, FL 33716

Vice President

Name Role Address
GRISE, JOHN P Vice President 11880N 28TH STREET N, SUITE 200, ST. PETERSBURG, FL 33716

President

Name Role Address
Breton, Randolph President 11880 28th Street North, St. Petersburgh, FL 33716

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2025-01-21 Sargis, Knyazyan No data
REGISTERED AGENT ADDRESS CHANGED 2019-02-11 11880 28TH STREET N, SUITE 200, St. Petersburg, FL 33716 No data
AMENDMENT 2013-09-03 No data No data
CHANGE OF PRINCIPAL ADDRESS 2012-04-10 11880 28TH STREET NORTH, SUITE 200, ST PETERSBURG, FL 33716 No data
CHANGE OF MAILING ADDRESS 2012-04-10 11880 28TH STREET NORTH, SUITE 200, ST PETERSBURG, FL 33716 No data
AMENDMENT 2004-12-15 No data No data
REINSTATEMENT 1995-09-19 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 1995-08-25 No data No data
AMENDMENT 1993-04-07 No data No data

Documents

Name Date
ANNUAL REPORT 2025-01-21
ANNUAL REPORT 2024-04-03
ANNUAL REPORT 2023-03-03
ANNUAL REPORT 2022-02-01
ANNUAL REPORT 2021-02-02
ANNUAL REPORT 2020-03-02
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-11
ANNUAL REPORT 2016-03-17

Related by officers

KAZARIAN, DAVID W

INFUSERVE MONROE, INC. INFUSERVE CONNECTICUT, INC. INFUSERVE TAMPA, INC. INFUSERVE DENVER, INC.

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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