{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "405 HERON DRIVE",
"SecondLineMailingAddress": "SUITE 200",
"MailingAddressCityName": "SWEDESBORO",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08085",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-331-8272",
"MailingAddressFaxNumber": "856-491-4365",
"FirstLinePracticeLocationAddress": "4340 GEORGETOWN ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEXINGTON",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40511-9115",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "859-389-7470",
"PracticeLocationAddressFaxNumber": "856-491-4365",
"EnumerationDate": "01/10/2022",
"LastUpdateDate": "05/27/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERNAL-ANGEL",
"AuthorizedOfficialFirstName": "ALEJANDRO",
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"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER, SECRETARY",
"AuthorizedOfficialNamePrefix": null,
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"AuthorizedOfficialTelephoneNumber": "973-307-7154",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336M0002X",
"TaxonomyName": "Mail Order Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}