Active NPI
Maylis Peguy L Nkeng Peh
- Pharmacist
- Tyler, TX
National Provider Identifier
1669086831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 67280
- Practice address
- 1620 S Broadway Ave
Tyler, TX 75701-4260 - Phone
- (903) 533-0367
- NPI assigned
- Sep 3, 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 | 67280 | TX | Primary |
Addresses
Primary practice location
1620 S Broadway Ave
Tyler, TX 75701-4260
Mailing address
322 Ambrose Ave
Tyler, TX 75704-2028
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 |
|---|---|---|---|
| 67280 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1620 S Broadway Ave
Tyler, TX 75701
Phone (903) 533-0367
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599091200000",
"number": "1669086831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "322 AMBROSE AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757042028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 S BROADWAY AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757014260",
"telephone_number": "903-533-0367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NKENG PEH",
"first_name": "MAYLIS PEGUY",
"middle_name": "L",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-03",
"last_updated": "2020-09-03",
"certification_date": "2020-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "TX",
"license": "67280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.