{
"Npi": {
"NPI": "1265897953",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CURERX 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": "5060 W SUNSET BLVD STE C",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90027-5872",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "323-667-1111",
"MailingAddressFaxNumber": "323-667-1131",
"FirstLinePracticeLocationAddress": "18625 SHERMAN WAY STE 107",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RESEDA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91335-4187",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-881-2998",
"PracticeLocationAddressFaxNumber": "818-881-2996",
"EnumerationDate": "12/22/2015",
"LastUpdateDate": "10/25/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ETTEDGUI",
"AuthorizedOfficialFirstName": "PHILIP",
"AuthorizedOfficialMiddleName": "AARON",
"AuthorizedOfficialTitle": "CEO AND PHARMACIST IN CHARGE",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "818-259-5375",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "30520",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "53473",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}