{
"Npi": {
"NPI": "1346685815",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SURYA RX SERVICES INC",
"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": "590 N SIERRA WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN BERNARDINO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92410-4817",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-495-3599",
"MailingAddressFaxNumber": "909-497-3132",
"FirstLinePracticeLocationAddress": "590 N SIERRA WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN BERNARDINO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92410-4817",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-495-3599",
"PracticeLocationAddressFaxNumber": "909-497-3132",
"EnumerationDate": "05/09/2013",
"LastUpdateDate": "03/04/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOTHARI",
"AuthorizedOfficialFirstName": "VATSAL",
"AuthorizedOfficialMiddleName": "P.",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "909-495-3599",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "51026",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}