{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BURBANK COMPOUNDING PHARMACY INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "201 S BUENA VISTA ST",
"SecondLineMailingAddress": "STE 110",
"MailingAddressCityName": "BURBANK",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91505-4569",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-563-2120",
"MailingAddressFaxNumber": "818-563-2130",
"FirstLinePracticeLocationAddress": "201 S BUENA VISTA ST",
"SecondLinePracticeLocationAddress": "STE 110",
"PracticeLocationAddressCityName": "BURBANK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91505-4569",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-563-2120",
"PracticeLocationAddressFaxNumber": "818-563-2130",
"EnumerationDate": "07/22/2006",
"LastUpdateDate": "10/07/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TATEVOSSIAN",
"AuthorizedOfficialFirstName": "ARMEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D",
"AuthorizedOfficialTelephoneNumber": "818-563-2120",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY48873",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}