{
"Npi": {
"NPI": "1215250238",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MMR SUPERMARKET INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1657",
"SecondLineMailingAddress": "FARMACIA DON MODE",
"MailingAddressCityName": "TRUJILLO ALTO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00977-1657",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "CARR 183, KM 1",
"SecondLinePracticeLocationAddress": "SAN LORENZO SHOPPING CENTER",
"PracticeLocationAddressCityName": "SAN LORENZO",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00754",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-715-1770",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/04/2010",
"LastUpdateDate": "10/01/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VIDAL",
"AuthorizedOfficialFirstName": "IGNACIO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ATTORNEY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-751-9393",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "16F2799",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}