Healthcare Provider Details

I. General information

NPI: 1093315616
Provider Name (Legal Business Name): MATTHEW SYKORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2020
Last Update Date: 11/01/2020
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 S IH 35
AUSTIN TX
78748-3885
US

IV. Provider business mailing address

9900 S IH 35
AUSTIN TX
78748-3885
US

V. Phone/Fax

Practice location:
  • Phone: 512-582-4883
  • Fax:
Mailing address:
  • Phone: 512-582-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number39872
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: