{
"Npi": {
"NPI": "1013631654",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MOFFETTRX LLC",
"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": "2000 24TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERIDIAN",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39301-3120",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-693-0033",
"MailingAddressFaxNumber": "601-693-0062",
"FirstLinePracticeLocationAddress": "2000 24TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MERIDIAN",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39301-3120",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-693-0033",
"PracticeLocationAddressFaxNumber": "601-693-0062",
"EnumerationDate": "09/27/2022",
"LastUpdateDate": "09/27/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOFFETT",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "ANDREW",
"AuthorizedOfficialTitle": "OWNER/PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "601-693-0033",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}