{
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"OrgName": "KEFALOS PHARMACY INC",
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"FirstLineMailingAddress": "1227 150TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WHITESTONE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11357-1747",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1227A 150TH ST",
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"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressFaxNumber": "347-732-4532",
"EnumerationDate": "08/08/2018",
"LastUpdateDate": "04/04/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LYMBERATOS",
"AuthorizedOfficialFirstName": "DIMITRIOS",
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"AuthorizedOfficialTitle": "OWNER/ PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "646-476-1881",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
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"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}