{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HILLRISE PHARMACY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4240 N BROAD ST UNIT B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19140-1908",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-403-7300",
"MailingAddressFaxNumber": "267-335-3937",
"FirstLinePracticeLocationAddress": "4240 N BROAD ST UNIT B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHILADELPHIA",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-403-7300",
"PracticeLocationAddressFaxNumber": "267-335-3937",
"EnumerationDate": "05/23/2016",
"LastUpdateDate": "07/27/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BADEJOKO",
"AuthorizedOfficialFirstName": "OMOTAYO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEMBER/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "B PHARM",
"AuthorizedOfficialTelephoneNumber": "484-326-1877",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PP482646",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}