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GEM STATE PHARMACY LLC

GEM STATE PHARMACY LLC

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Company Details

Name:	GEM STATE PHARMACY LLC
Jurisdiction:	Idaho
Legal type:	Limited Liability Company (D)
Status:	Active-Existing
Date of registration:	01 Apr 2024 (a year ago)
Financial Date End:	30 Apr 2026
Entity Number:	5664839
Place of Formation:	IDAHO
File Number:	929565
ZIP code:	83301
County:	Twin Falls County
Principal Address:	GEM STATE PHARMACY STE 200 RM 7 1437 PARKVIEW DR TWIN FALLS, ID 83301
Mailing Address:	1516 W BLUE DOWNS ST MERIDIAN, ID 83642-8496

Manager

Name	Role	Address	Appointed On
Sforza LLC	Manager	1516 W BLUE DOWNS ST, MERIDIAN, ID 83642	2025-05-06

Agent

Name	Role	Address
SFORZA LLC	Agent	1516 W BLUE DOWNS ST, MERIDIAN, ID 83642

National Provider Identifier

NPI Number:

1730926080

Certification Date:

2024-10-02

Link:

View on NPI website

Authorized Person:

Name:

MR. MATTHEW HAVILI

Role:

MANAGER

Phone:

2083296104

Taxonomy:

Selected Taxonomy:

3336C0004X - Compounding Pharmacy

Is Primary:

Yes

Contacts:

Phone:

+1 208-329-6104

Fax:

2086096290

Filing

Filing Name	Filing Number	Filing date
Annual Report	0006242088	2025-05-06
Amendment to Certificate	0005746761	2024-05-23
Amendment to Certificate	0005676224	2024-04-05
Initial Filing	0005664839	2024-04-01

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Date of last update: 22 May 2025

Sources: Idaho Secretary of State