{
"Npi": {
"NPI": "1336485663",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ELWYN PHARMACY GROUP, LLC",
"ParentOrgTIN": null,
"OrgName": "CMC 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": "3100 MACCORKLE AVE SE",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "CHARLESTON",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25304-1223",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-344-8021",
"MailingAddressFaxNumber": "304-344-0655",
"FirstLinePracticeLocationAddress": "3100 MACCORKLE AVE SE STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHARLESTON",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25304-1215",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-344-8021",
"PracticeLocationAddressFaxNumber": "304-344-0655",
"EnumerationDate": "12/13/2012",
"LastUpdateDate": "08/02/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KARALIS",
"AuthorizedOfficialFirstName": "NICHOLAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO & PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "610-545-6040",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336H0001X",
"TaxonomyName": "Home Infusion Therapy Pharmacy",
"LicenseNumber": "SP0552442",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336S0011X",
"TaxonomyName": "Specialty Pharmacy",
"LicenseNumber": "SP0552442",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "SP0552442",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}