Active NPI
Thavory Sokon Samoeun
- Pharmacist
- St Augustine, FL
National Provider Identifier
1053283119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 42516
- Practice address
- 22 Fremont Ave
Saint Augustine, FL 32095-8646 - Phone
- (904) 412-6549
- NPI assigned
- Sep 18, 2025
- Last updated
- Sep 18, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 42516 | FL | Primary |
Addresses
Primary practice location
22 Fremont Ave
Saint Augustine, FL 32095-8646
Mailing address
22 Fremont Ave
Saint Augustine, FL 32095-8646
Phone (904) 412-6549
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42516 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758153600000",
"number": "1053283119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 FREMONT AVE",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "320958646",
"telephone_number": "904-412-6549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 FREMONT AVE",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "320958646",
"telephone_number": "904-412-6549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMOEUN",
"first_name": "THAVORY",
"middle_name": "SOKON",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-09-18",
"last_updated": "2025-09-18",
"certification_date": "2025-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "FL",
"license": "42516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.