| Entity Name: | FIVE POINTS PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Aug 1991 (33 years ago) |
| Document Number: | S76406 |
| FEI/EIN Number | 593105441 |
| Address: | 1108 LAKE DRIVE, COCOA, FL, 32922 |
| Mail Address: | 1914 SPRING CREEK RD, WAVERLY, TN, 37185 |
| ZIP code: | 32922 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326032210 | 2005-09-07 | 2020-08-22 | 1108 LAKE DR, COCOA, FL, 329228678, US | 1108 LAKE DR, COCOA, FL, 329228678, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 321-636-8433 |
| Fax | 4076345003 |
Authorized person
| Name | DONNA HARRISON FLINT |
| Role | MGR |
| Phone | 3216368433 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH0002574 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 10024600 |
| State | FL |
| Issuer | OTHER ID NUMBER-COMMERCIAL NUMBER |
| Number | 1003160 |
| Name | Role | Address |
|---|---|---|
| MANNEY KENNETH J | Agent | 7020 SOUTH A1A, MELBOURNE BEACH, FL, 32951 |
| Name | Role | Address |
|---|---|---|
| STANCO JERRILYN H | President | 1914 SPRING CREEK RD, WAVERLY, TN, 37185 |
| Name | Role | Address |
|---|---|---|
| STANCO JERRILYN H | Secretary | 1914 SPRING CREEK RD., WAVERLY, TN, 37185 |
| Name | Role | Address |
|---|---|---|
| STANCO JERRILYN H | Treasurer | 1914 SPRING CREEK RD., WAVERLY, TN, 37185 |
| Name | Role | Address |
|---|---|---|
| STANCO JERRILYN H | Director | 1914 SPRING CREEK RD., WAVERLY, TN, 37185 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2011-05-25 | No data | No data |
| REINSTATEMENT | 2010-07-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2008-11-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000612076 | LAPSED | 1000000616041 | LEON | 2014-04-28 | 2024-05-09 | $ 969.75 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| J12000864135 | LAPSED | 1000000310034 | LEON | 2012-11-19 | 2022-11-28 | $ 1,271.62 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
