{
"Npi": {
"NPI": "1366751752",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VICTORY PHARMACY CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11328 TARA BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAMPTON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30228-6229",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-519-3376",
"MailingAddressFaxNumber": "678-519-3404",
"FirstLinePracticeLocationAddress": "11328 TARA BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAMPTON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30228-6229",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-519-3376",
"PracticeLocationAddressFaxNumber": "678-519-3404",
"EnumerationDate": "10/01/2010",
"LastUpdateDate": "04/11/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MBADUGHA",
"AuthorizedOfficialFirstName": "HILARY",
"AuthorizedOfficialMiddleName": "JACK",
"AuthorizedOfficialTitle": "PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "404-625-0387",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHRE009684",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}