{
"Npi": {
"NPI": "1073078325",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STAYWELL PHARMACY CORP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "912 E NORTHWEST HWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALATINE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60074-6506",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-496-5559",
"MailingAddressFaxNumber": "847-496-5437",
"FirstLinePracticeLocationAddress": "912 E NORTHWEST HWY UNIT C-131",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALATINE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60074-6506",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-942-3110",
"PracticeLocationAddressFaxNumber": "847-496-5437",
"EnumerationDate": "01/31/2019",
"LastUpdateDate": "05/08/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAREEF",
"AuthorizedOfficialFirstName": "SADATHULLA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "516-859-4292",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}