Organization
CYPRESS PHARMACY INC
Active
Other names
Cypress Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN R CERAVOLO PHARMD (OWNER)
(239) 481-7322
Entity
Organization
Contact information
Practice address
9451 CYPRESS LAKE DR, FORT MYERS, FL 33919-4909
(239) 481-7322
(239) 481-0151
Mailing address
9451 CYPRESS LAKE DR, FORT MYERS, FL 33919-4909
(239) 481-7322
(239) 481-0151
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH23348
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108040900
—
FL
Enumeration date
10/27/2006
Last updated
05/30/2024
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