Provider Demographics
NPI:1629158100
Name:CYPRESS CENTER PHARMACY, INC.
Entity Type:Organization
Organization Name:CYPRESS CENTER PHARMACY, INC.
Other - Org Name:COREY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:772-231-6931
Mailing Address - Street 1:2912 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1949
Mailing Address - Country:US
Mailing Address - Phone:772-231-6931
Mailing Address - Fax:772-231-0731
Practice Address - Street 1:2912 OCEAN DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1949
Practice Address - Country:US
Practice Address - Phone:772-231-6931
Practice Address - Fax:772-231-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34879183500000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008511500Medicaid