Healthcare Provider Details

I. General information

NPI: 1790133536
Provider Name (Legal Business Name): JOHN SYKORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 8TH ST
SEAL BEACH CA
90740-6305
US

IV. Provider business mailing address

225 8TH STREET
SEAL BEACH CA
90740
US

V. Phone/Fax

Practice location:
  • Phone: 562-773-1271
  • Fax:
Mailing address:
  • Phone: 562-773-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: