{
"Npi": {
"NPI": "1003976028",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LAKE AREA PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1004 FORTUNE RD STE 6",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YOUNGSVILLE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70592-5793",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "337-450-3052",
"MailingAddressFaxNumber": "337-450-3053",
"FirstLinePracticeLocationAddress": "1004 FORTUNE RD STE 6",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YOUNGSVILLE",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70592-5793",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "337-450-3052",
"PracticeLocationAddressFaxNumber": "337-450-3053",
"EnumerationDate": "12/11/2006",
"LastUpdateDate": "09/09/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLOUD",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": "SCOTT",
"AuthorizedOfficialTitle": "DIRECTOR OF PHARMACY",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "337-721-1931",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "5129-IR",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}