{
"Npi": {
"NPI": "1215088208",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRIMARY CARE PHARMACY SERVICES INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherMiddleName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2550 MOSSIDE BLVD",
"SecondLineMailingAddress": "STE 210",
"MailingAddressCityName": "MONROEVILLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15146-3540",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "412-380-5230",
"MailingAddressFaxNumber": "412-380-5233",
"FirstLinePracticeLocationAddress": "2550 MOSSIDE BLVD",
"SecondLinePracticeLocationAddress": "STE 210",
"PracticeLocationAddressCityName": "MONROEVILLE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "15146-3540",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "412-380-5230",
"PracticeLocationAddressFaxNumber": "412-380-5233",
"EnumerationDate": "01/16/2007",
"LastUpdateDate": "10/04/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERTOLA",
"AuthorizedOfficialFirstName": "ANTHONY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER PHCST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "412-583-6332",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PP481636",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}