{
"Npi": {
"NPI": "1114570504",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCE CARE RX PHARMACY",
"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": "12097 CONANT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAMTRAMCK",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48212-2716",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-826-1713",
"MailingAddressFaxNumber": "313-826-1714",
"FirstLinePracticeLocationAddress": "12097 CONANT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAMTRAMCK",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48212-2716",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-826-1713",
"PracticeLocationAddressFaxNumber": "313-826-1714",
"EnumerationDate": "07/24/2019",
"LastUpdateDate": "10/28/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PIZZUTI",
"AuthorizedOfficialFirstName": "ANNE",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER/RPH",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "313-826-1713",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}