{
"Npi": {
"NPI": "1346611225",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KL PHARMACY CORPORATION",
"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": "4718 W 1ST ST STE 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA ANA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92703-3106",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "657-231-6850",
"MailingAddressFaxNumber": "888-671-7563",
"FirstLinePracticeLocationAddress": "4718 W 1ST ST STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANTA ANA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92703-3106",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "657-231-6850",
"PracticeLocationAddressFaxNumber": "888-671-7563",
"EnumerationDate": "10/17/2015",
"LastUpdateDate": "03/08/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAM",
"AuthorizedOfficialFirstName": "KATRINA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO/PHARMACIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D",
"AuthorizedOfficialTelephoneNumber": "714-856-7925",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "54227",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}