{
"Npi": {
"NPI": "1336221910",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VAN 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": "4502 N PERSHING AVE",
"SecondLineMailingAddress": "#AB",
"MailingAddressCityName": "STOCKTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95207",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-478-9868",
"MailingAddressFaxNumber": "209-478-6930",
"FirstLinePracticeLocationAddress": "4502 N PERSHING AVE",
"SecondLinePracticeLocationAddress": "#AB",
"PracticeLocationAddressCityName": "STOCKTON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95207",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-478-9868",
"PracticeLocationAddressFaxNumber": "209-478-6930",
"EnumerationDate": "10/20/2006",
"LastUpdateDate": "02/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DANG",
"AuthorizedOfficialFirstName": "VAN",
"AuthorizedOfficialMiddleName": "THI HONG",
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "209-478-9868",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "PHY41834",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}