Provider Demographics
NPI:1457999229
Name:CYREENE
Entity Type:Organization
Organization Name:CYREENE
Other - Org Name:CYREENE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LEAD PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:AIDOO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-481-9928
Mailing Address - Street 1:43944 SWIFT FOX DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-7136
Mailing Address - Country:US
Mailing Address - Phone:301-481-9928
Mailing Address - Fax:301-263-7925
Practice Address - Street 1:25805 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2013
Practice Address - Country:US
Practice Address - Phone:240-309-4101
Practice Address - Fax:240-309-4094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CYREENE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-12
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy