{
"Npi": {
"NPI": "1225121577",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SAN MIGUEL PHARMACY,INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4476 TWEEDY BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTH GATE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90280-6359",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "323-563-3233",
"MailingAddressFaxNumber": "323-563-3934",
"FirstLinePracticeLocationAddress": "4476 TWEEDY BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTH GATE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90280-6359",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "323-563-3233",
"PracticeLocationAddressFaxNumber": "323-563-3934",
"EnumerationDate": "10/01/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ARUTYUNYAN",
"AuthorizedOfficialFirstName": "GRACHUY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO,PHARMACIST IN CHARGE",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "323-563-3233",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "46505",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}