Provider Demographics
NPI:1649833633
Name:CYPRESS CREEK PHARMACY LLC
Entity type:Organization
Organization Name:CYPRESS CREEK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-994-9600
Mailing Address - Street 1:26829 TANIC DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4612
Mailing Address - Country:US
Mailing Address - Phone:813-994-9600
Mailing Address - Fax:813-994-9696
Practice Address - Street 1:26829 TANIC DR STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4612
Practice Address - Country:US
Practice Address - Phone:813-994-9600
Practice Address - Fax:813-994-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy