{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "PACKER APOTHECARY",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1532 PACKER AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19145-5407",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "267-909-9214",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1532 PACKER AVE",
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"PracticeLocationAddressCityName": "PHILADELPHIA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "267-909-9814",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/27/2010",
"LastUpdateDate": "02/29/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAUZANO",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANANGER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "267-266-9270",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pharmacy",
"LicenseNumber": "PP482031",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}