{
"Npi": {
"NPI": "1225477862",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MALABAR 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": "930 MALABAR RD SE STE 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALM BAY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32907-3252",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "321-775-0911",
"MailingAddressFaxNumber": "877-232-9689",
"FirstLinePracticeLocationAddress": "930 MALABAR RD SE STE 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALM BAY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32907-3252",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "321-775-0911",
"PracticeLocationAddressFaxNumber": "877-232-9689",
"EnumerationDate": "06/17/2013",
"LastUpdateDate": "02/05/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAH",
"AuthorizedOfficialFirstName": "ANKUR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER/PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "321-775-0911",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}