{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUN PHARMACY INC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6350 BROOKLYN BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKLYN CENTER",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55429",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "763-561-0722",
"MailingAddressFaxNumber": "763-561-0723",
"FirstLinePracticeLocationAddress": "6350 BROOKLYN BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BROOKLYN CENTER",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55429-2669",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "763-561-0722",
"PracticeLocationAddressFaxNumber": "763-561-0723",
"EnumerationDate": "07/19/2012",
"LastUpdateDate": "07/19/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KUE",
"AuthorizedOfficialFirstName": "PAO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "763-561-0722",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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"LicenseNumber": "263920",
"LicenseNumberStateCode": "MN",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}