| Entity Name: | C & C COMMUNITY PHARMACY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 04 May 1992 (33 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 02 Aug 2024 (6 months ago) |
| Document Number: | V34291 |
| FEI/EIN Number | 59-3119588 |
| Address: | 3116 WOODHAVEN DRIVE, VESTAVIA, AL 35243 |
| Mail Address: | 3116 WOODHAVEN DRIVE, VESTAVIA, AL 35243 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285702084 | 2006-12-01 | 2024-10-11 | 927 S. GOLDWYN AVE #111, ORLANDO, FL, 32805, US | 927 S. GOLDWYN AVE #111, ORLANDO, FL, 32805, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-295-6201 |
| Fax | 4072950306 |
Authorized person
| Name | MR. BRETT R. TAFT |
| Role | OWNER |
| Phone | 2052180815 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH12052 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PK |
| Number | 2011331 |
| Issuer | MEDICAID |
| Number | 682675096 |
| State | FL |
| Issuer | MEDICAID |
| Number | 101947300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZIBAS, JURA | Agent | 2063 MAIN STREET, SUITE 100, SARASOTA, FL 34237 |
| Name | Role | Address |
|---|---|---|
| RYAN TAFT, BRETT | President | 3116 WOODHAVEN DRIVE, VESTAVIA, AL 35243 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-08-02 | 3116 WOODHAVEN DRIVE, VESTAVIA, AL 35243 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-08-02 | ZIBAS, JURA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-08-02 | 2063 MAIN STREET, SUITE 100, SARASOTA, FL 34237 | No data |
| AMENDMENT | 2024-08-02 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2024-08-02 | 3116 WOODHAVEN DRIVE, VESTAVIA, AL 35243 | No data |
| CANCEL ADM DISS/REV | 2009-10-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| Amendment | 2024-08-02 |
| ANNUAL REPORT | 2024-03-25 |
| ANNUAL REPORT | 2023-04-09 |
| ANNUAL REPORT | 2022-04-11 |
| AMENDED ANNUAL REPORT | 2021-08-31 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-07-01 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-05-03 |
| ANNUAL REPORT | 2017-05-01 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
