{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "2900 W OKLAHOMA AVE",
"SecondLineMailingAddress": "SUITE 1001",
"MailingAddressCityName": "MILWAUKEE",
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"MailingAddressPostalCode": "53215-4330",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2900 W OKLAHOMA AVE",
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"PracticeLocationAddressCityName": "MILWAUKEE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "414-649-6930",
"PracticeLocationAddressFaxNumber": "414-649-5367",
"EnumerationDate": "07/13/2006",
"LastUpdateDate": "02/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RICHARDSON",
"AuthorizedOfficialFirstName": "KARA",
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"AuthorizedOfficialTitle": "VP MANAGED HEALTH",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "704-631-0450",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Institutional Pharmacy",
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"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}