{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STRIVE PHARMACY SAN DIEGO LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8950 VILLA LA JOLLA DRIVE",
"SecondLineMailingAddress": "SUITE C225",
"MailingAddressCityName": "LA JOLLA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92037-1713",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-270-8688",
"MailingAddressFaxNumber": "619-270-8660",
"FirstLinePracticeLocationAddress": "8950 VILLA LA JOLLA DRIVE",
"SecondLinePracticeLocationAddress": "SUITE C225",
"PracticeLocationAddressCityName": "LA JOLLA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92037-1713",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-270-8688",
"PracticeLocationAddressFaxNumber": "619-270-8660",
"EnumerationDate": "09/24/2021",
"LastUpdateDate": "09/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALKER",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "480-626-4366",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}