{
"Npi": {
"NPI": "1245784776",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MEDSHOP PHARMACY, INC.",
"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": "17100 NORWALK BLVD STE 108",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CERRITOS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90703-2750",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-210-8215",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "17100 NORWALK BLVD STE 108",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CERRITOS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90703-2750",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-210-8215",
"PracticeLocationAddressFaxNumber": "562-210-8228",
"EnumerationDate": "08/13/2016",
"LastUpdateDate": "06/17/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MONIS",
"AuthorizedOfficialFirstName": "ANNA MARIE",
"AuthorizedOfficialMiddleName": "CO",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "562-210-8215",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}