Individual provider Active NPI

Telfia Yvette Muckeroy, RPH

  • Ambulatory Care Pharmacist
  • Magnolia, TX
National Provider Identifier
1467964809
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Care PharmacistTaxonomy code 1835P2201X
License
32640 Issued in TX
Practice address
814 Honea Egypt Rd Ste 101
Magnolia, TX 77354-3864
Phone
(281) 974-2678
Fax
(281) 783-2436
NPI assigned
Oct 25, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 32640 TX
Ambulatory Care Pharmacist 1835P2201X 32640 TX Primary

Addresses

Primary practice location

814 Honea Egypt Rd Ste 101
Magnolia, TX 77354-3864

Mailing address

2502 Riverside Pkwy Apt 1028
Grand Prairie, TX 75050-7982
Phone (469) 662-6752

Other identifiers 2

IdentifierTypeStateIssuer
32640MedicaidTX
150188MedicaidTX

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
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
32640TXMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1508889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1467964809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 RIVERSIDE PKWY APT 1028",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750507982",
            "telephone_number": "469-662-6752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 HONEA EGYPT RD STE 101",
            "city": "MAGNOLIA",
            "state": "TX",
            "postal_code": "773543864",
            "telephone_number": "281-974-2678",
            "fax_number": "281-783-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUCKEROY",
        "first_name": "TELFIA",
        "middle_name": "YVETTE",
        "name_prefix": "Ms.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-25",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "32640",
            "primary": false
        },
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "TX",
            "license": "32640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32640",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150188",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Magnolia, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.