{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "519 MERIDAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DEARBORN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48124-1357",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-995-2595",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "28573 NORTHWESTERN HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTHFIELD",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48034-1824",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-841-4325",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/16/2021",
"LastUpdateDate": "06/02/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANOUTI",
"AuthorizedOfficialFirstName": "DANNY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "313-995-2595",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}