Provider Demographics
NPI:1871322453
Name:CYPRESS PHARMACY INC
Entity type:Organization
Organization Name:CYPRESS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CERAVOLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:239-481-7322
Mailing Address - Street 1:9451 CYPRESS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4909
Mailing Address - Country:US
Mailing Address - Phone:239-481-7322
Mailing Address - Fax:239-481-0151
Practice Address - Street 1:1700 PERIWINKLE WAY STE 7
Practice Address - Street 2:
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-4334
Practice Address - Country:US
Practice Address - Phone:239-481-7322
Practice Address - Fax:239-481-0151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CYPRESS PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy