{
"Npi": {
"NPI": "1174006399",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VILLAGE DISCOUNT PHARMACY",
"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": "3990 E SR 44 STE 207",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILDWOOD",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34785-7482",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-492-9333",
"MailingAddressFaxNumber": "352-399-6234",
"FirstLinePracticeLocationAddress": "3990 E ST 44 SUITE 207",
"SecondLinePracticeLocationAddress": "E SR44 SUITE 207",
"PracticeLocationAddressCityName": "WILDWOOD",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34785",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-492-3041",
"PracticeLocationAddressFaxNumber": "352-399-6234",
"EnumerationDate": "09/13/2018",
"LastUpdateDate": "09/19/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OMAR",
"AuthorizedOfficialFirstName": "GAMAL",
"AuthorizedOfficialMiddleName": "ABOUELWAFA",
"AuthorizedOfficialTitle": "OWNER /PIC",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "352-492-9333",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}