NPI Code Detail JSON Logo

1225049893 NPI number — CCD OPERATING LLC DBA CRESCENT CENTER DRUGS

NPI Number: 1225049893
Health Care Provider/Practitioner: CCD OPERATING LLC DBA CRESCENT CENTER DRUGS

Information about “1225049893” NPI (CCD OPERATING LLC DBA CRESCENT CENTER DRUGS) exists in 1225049893 in HTML format HTML  |  1225049893 in plain Text format TXT  |  1225049893 in PDF (Portable Document Format) PDF  |  1225049893 in an XML format XML  formats.

NPI Number : 1225049893 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225049893",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CCD OPERATING LLC DBA CRESCENT CENTER DRUGS",
    "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": "228 NORTH FAIRMONT AVAE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MORRISTOWN",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37814",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-586-6263",
    "MailingAddressFaxNumber": "423-587-5460",
    "FirstLinePracticeLocationAddress": "228 NORTH FAIRMONT AVAE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MORRISTOWN",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37814",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-586-6263",
    "PracticeLocationAddressFaxNumber": "423-587-5460",
    "EnumerationDate": "08/10/2006",
    "LastUpdateDate": "03/06/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KRAGEL",
    "AuthorizedOfficialFirstName": "DAVID",
    "AuthorizedOfficialMiddleName": "RYAN",
    "AuthorizedOfficialTitle": "OWNER/PHARMACIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHARM D",
    "AuthorizedOfficialTelephoneNumber": "423-586-6263",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "703",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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