Active NPI
Maureena Thavy Sam, RPH
- Pharmacist
- Lake Worth, TX
National Provider Identifier
1639773955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 37748
- Practice address
- 6640 Lake Worth Blvd
Lake Worth, TX 76135-3000 - Phone
- (817) 237-3363
- NPI assigned
- Nov 27, 2020
- Last updated
- Nov 27, 2020
- Sex
- Female
- 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 | 37748 | TX | Primary |
Addresses
Primary practice location
6640 Lake Worth Blvd
Lake Worth, TX 76135-3000
Mailing address
6640 Lake Worth Blvd
Lake Worth, TX 76135-3000
Phone (817) 237-3363
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
| License | State | Type | Specialty |
|---|---|---|---|
| 37748 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606435200000",
"number": "1639773955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6640 LAKE WORTH BLVD",
"city": "LAKE WORTH",
"state": "TX",
"postal_code": "761353000",
"telephone_number": "817-237-3363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6640 LAKE WORTH BLVD",
"city": "LAKE WORTH",
"state": "TX",
"postal_code": "761353000",
"telephone_number": "817-237-3363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAM",
"first_name": "MAUREENA",
"middle_name": "THAVY",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-27",
"last_updated": "2020-11-27",
"certification_date": "2020-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "37748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.