{
"Npi": {
"NPI": "1053671800",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MISHNIK PHARMACY SERVICES, 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": "PO BOX 940816",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SIMI VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93094-0816",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-258-6569",
"MailingAddressFaxNumber": "805-823-7767",
"FirstLinePracticeLocationAddress": "1960 SEQUOIA AVE",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "SIMI VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93063-3176",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-416-8900",
"PracticeLocationAddressFaxNumber": "805-823-7767",
"EnumerationDate": "05/25/2012",
"LastUpdateDate": "05/25/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MASIH",
"AuthorizedOfficialFirstName": "AMGAD",
"AuthorizedOfficialMiddleName": "MOHSEN",
"AuthorizedOfficialTitle": "CHIEF PHARMACIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "805-258-6569",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "50179",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}