Provider Demographics
NPI:1740079383
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:
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 1:9451 CYPRESS LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4909
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:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy