{
"Npi": {
"NPI": "1316470123",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTERDEPENDENT PHARMACY, LLC",
"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": "1778 SOMERSET LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MUNDELEIN",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60060-5363",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "224-392-2666",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "404 N SEYMOUR AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MUNDELEIN",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60060-1835",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "224-475-0020",
"PracticeLocationAddressFaxNumber": "224-475-0849",
"EnumerationDate": "04/07/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STRAKUSEK",
"AuthorizedOfficialFirstName": "BYRON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH.",
"AuthorizedOfficialTelephoneNumber": "224-392-2666",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}