Provider Demographics
NPI:1366049983
Name:CYPRESS CARE PHARMACY
Entity type:Organization
Organization Name:CYPRESS CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUJITH
Authorized Official - Middle Name:
Authorized Official - Last Name:IDICULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-529-5546
Mailing Address - Street 1:970 CYPRESS VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6830
Mailing Address - Country:US
Mailing Address - Phone:863-529-5546
Mailing Address - Fax:813-642-0698
Practice Address - Street 1:970 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6830
Practice Address - Country:US
Practice Address - Phone:863-529-5546
Practice Address - Fax:813-642-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy