{
"Npi": {
"NPI": "1205381803",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PAHOA PHARMACY LLC",
"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": "PO BOX 11",
"SecondLineMailingAddress": "15-2660 PAHOA VILLAGE ROAD SUITE 205",
"MailingAddressCityName": "PAHOA",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96778-0011",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-965-0601",
"MailingAddressFaxNumber": "808-965-0603",
"FirstLinePracticeLocationAddress": "15-2660 PAHOA VILLAGE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PAHOA",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96778-6720",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-965-0601",
"PracticeLocationAddressFaxNumber": "808-965-0603",
"EnumerationDate": "08/24/2016",
"LastUpdateDate": "02/14/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABDOLAHI",
"AuthorizedOfficialFirstName": "ISMAIL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER, PIC, AO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "808-494-8960",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY-909",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}