Healthcare Provider Details

I. General information

NPI: 1346119245
Provider Name (Legal Business Name): ERNIE L. SYKORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S 32ND ST
MUSKOGEE OK
74401-5007
US

IV. Provider business mailing address

3910 S DOGWOOD PL
BROKEN ARROW OK
74011-1776
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-0611
  • Fax: 918-683-0620
Mailing address:
  • Phone: 918-683-0611
  • Fax: 918-683-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7976
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: