{
"Npi": {
"NPI": "1134419583",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RYAN PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "23421 RYAN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WARREN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48091-1927",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-755-0040",
"MailingAddressFaxNumber": "586-755-0044",
"FirstLinePracticeLocationAddress": "23421 RYAN RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARREN",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48091-1927",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-755-0040",
"PracticeLocationAddressFaxNumber": "586-755-0044",
"EnumerationDate": "04/19/2011",
"LastUpdateDate": "07/21/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YACOUB",
"AuthorizedOfficialFirstName": "RULA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "586-755-0040",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "5301009555",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}