{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "SPECTRA PHARMACY INC.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2926 NEWTOWN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ASTORIA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11102-2297",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "347-507-0113",
"MailingAddressFaxNumber": "347-507-0114",
"FirstLinePracticeLocationAddress": "2926 NEWTOWN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ASTORIA",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "347-507-0113",
"PracticeLocationAddressFaxNumber": "347-507-0114",
"EnumerationDate": "08/10/2023",
"LastUpdateDate": "08/10/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEVY",
"AuthorizedOfficialFirstName": "DAVID",
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"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "917-528-2755",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}