{
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"IsOrgSubpart": "N",
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"OrgName": "41 AVENUE PHARMACY, LLC",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "136-33 37TH AVENUE UNIT #1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLUSHING",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11354-5874",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-353-8600",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "13633 37TH AVE UNIT 1A",
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"PracticeLocationAddressCityName": "FLUSHING",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-353-8600",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/10/2012",
"LastUpdateDate": "02/10/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIU",
"AuthorizedOfficialFirstName": "TRISTAN",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "646-504-7321",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "031475",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}