Healthcare Provider Details

I. General information

NPI: 1548569932
Provider Name (Legal Business Name): MICHAEL THOMAS CYRUS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E SUNRISE BLVD
FORT LAUDERDALE FL
33304-2324
US

IV. Provider business mailing address

2924 NW 10TH AVE
WILTON MANORS FL
33311-2204
US

V. Phone/Fax

Practice location:
  • Phone: 954-888-8980
  • Fax: 954-888-8988
Mailing address:
  • Phone: 703-966-4061
  • Fax: 954-888-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0202011373
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS48872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: