{
"Npi": {
"NPI": "1245878867",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "WELLS PHARMACY",
"ParentOrgTIN": null,
"OrgName": "WELLS PHARMACY",
"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": "247 N LITCHFIELD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GOODYEAR",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85338-1227",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-932-3040",
"MailingAddressFaxNumber": "623-932-3961",
"FirstLinePracticeLocationAddress": "247 N LITCHFIELD RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GOODYEAR",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85338-1227",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "623-932-3040",
"PracticeLocationAddressFaxNumber": "623-932-3961",
"EnumerationDate": "12/13/2019",
"LastUpdateDate": "01/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KURTIS",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "FRANK",
"AuthorizedOfficialTitle": "OWNER/PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "623-932-3040",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}