Cypress Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH23348 Issued in FL

Legal business name

CYPRESS PHARMACY INC

Doing business as

Cypress Pharmacy

Practice address

9451 Cypress Lake Dr
Fort Myers, FL 33919-4909

Phone

(239) 481-7322

Fax

(239) 481-0151

NPI assigned

Oct 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Justin R Ceravolo, PHARMD

Title

Owner

Phone

(239) 481-7322

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Cypress Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Tax ID family

Cypress Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Cypress Pharmacy Inc

  dba Island Wellness Pharmacy

  • Community/Retail Pharmacy
  • Sanibel, FL
  • NPI 1871322453
  NPD tax ID
• Cypress Pharmacy, Inc

  dba Cypress Wellness LTC

  • Long Term Care Pharmacy
  • Fort Myers, FL
  • NPI 1740079383
  NPD tax ID

Locations

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Cypress Pharmacy Inc

  dba Island Wellness Pharmacy

  • Community/Retail Pharmacy
  • Sanibel, FL
  • NPI 1871322453
  NPPES parent name
• Cypress Pharmacy, Inc

  dba Cypress Wellness LTC

  • Long Term Care Pharmacy
  • Fort Myers, FL
  • NPI 1740079383
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1487739215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9451 CYPRESS LAKE DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194909",
            "telephone_number": "239-481-7322",
            "fax_number": "239-481-0151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9451 CYPRESS LAKE DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194909",
            "telephone_number": "239-481-7322",
            "fax_number": "239-481-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CYPRESS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "CERAVOLO",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-481-7322",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH23348",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108040900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cypress Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cypress Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cypress Family Medical Center PA
• Cypress Home Medical Inc (Option Care of Southwest Florida)
• Cypress Lake Eye Care LLC
• Cypress Manor Health Care Associates, LLC (Cypress Community Care Center)
• Cypress Medical Associates of SWFL Inc
• Cypress Pharmacy, Inc (Cypress Wellness LTC)
• Cypress Rehab Center
• Cypress Square Health Care Associates, LLC (Cypress Square Villas)
• Hannah Cyr, AA
• Jacob Mark Czajka, PA-C

• Community/Retail Pharmacy in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.