{
"Npi": {
"NPI": "1033362421",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NALLE PHARMACY INC",
"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": "1918 RANDOLPH RD",
"SecondLineMailingAddress": "SUITE 120",
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28207-1100",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-342-8180",
"MailingAddressFaxNumber": "704-344-2243",
"FirstLinePracticeLocationAddress": "1918 RANDOLPH RD",
"SecondLinePracticeLocationAddress": "SUITE 120",
"PracticeLocationAddressCityName": "CHARLOTTE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28207-1100",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-342-8180",
"PracticeLocationAddressFaxNumber": "704-344-2243",
"EnumerationDate": "10/29/2008",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ULRICH",
"AuthorizedOfficialFirstName": "LORI",
"AuthorizedOfficialMiddleName": "WILSON",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D.",
"AuthorizedOfficialTelephoneNumber": "704-342-8180",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": "7565",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}