{
"Npi": {
"NPI": "1336373273",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FARMACIA CONDADO MODERNO",
"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": "CIUDAD JARDIN VILLAS DE GOLF 9",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GURABO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00778",
"MailingAddressCountryCode": "UM",
"MailingAddressTelephoneNumber": "939-717-4634",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "URB CONDADO MODERNO",
"SecondLinePracticeLocationAddress": "C 18 M21",
"PracticeLocationAddressCityName": "CAGUAS",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00725",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-961-6770",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/06/2009",
"LastUpdateDate": "05/06/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HERNANDEZ",
"AuthorizedOfficialFirstName": "MIGUEL",
"AuthorizedOfficialMiddleName": "ANGEL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "939-717-4634",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "11-F-2721",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}