MEDICARE: CYPRESS CARE PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1366049983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS CARE PHARMACY

Provider Business Mailing Address
First Line	:	970 CYPRESS VILLAGE BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6830
Country	:	US
Telephone Number	:	863-529-5546
Fax Number	:	813-642-0698

Provider Business Practice Location Address
First Line	:	970 CYPRESS VILLAGE BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6830
Country	:	US
Telephone Number	:	863-529-5546
Fax Number	:	813-642-0698

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. SUJITH IDICULLA
Credential	:
Telephone Number	:	863-529-5546

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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