{
"Npi": {
"NPI": "1053533810",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PANACEA BIOMATX INC",
"ParentOrgTIN": null,
"OrgName": "TRIANGLE COMPOUNDING 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": "3700 REGENCY PARKWAY",
"SecondLineMailingAddress": "STE 140",
"MailingAddressCityName": "CARY",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27518-7412",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-858-0809",
"MailingAddressFaxNumber": "919-858-5145",
"FirstLinePracticeLocationAddress": "3700 REGENCY PKWY",
"SecondLinePracticeLocationAddress": "STE 140",
"PracticeLocationAddressCityName": "CARY",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27518-8696",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-858-0809",
"PracticeLocationAddressFaxNumber": "919-858-5145",
"EnumerationDate": "05/02/2007",
"LastUpdateDate": "12/23/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARNES",
"AuthorizedOfficialFirstName": "DANNY",
"AuthorizedOfficialMiddleName": "MACK",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "919-858-0809",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "15485",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}