{
"Npi": {
"NPI": "1386067007",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MEDRX SPECIALTY PHARMACY, LLC.",
"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": "P.O. BOX 2188",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CYPRESS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77410",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "713-303-3189",
"MailingAddressFaxNumber": "855-848-1141",
"FirstLinePracticeLocationAddress": "4726 E TEXAS ST",
"SecondLinePracticeLocationAddress": "SUITE 230",
"PracticeLocationAddressCityName": "BOSSIER CITY",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "71111-2545",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "855-825-5014",
"PracticeLocationAddressFaxNumber": "855-848-1141",
"EnumerationDate": "01/31/2014",
"LastUpdateDate": "02/08/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
"AuthorizedOfficialFirstName": "JERMAINE",
"AuthorizedOfficialMiddleName": "CHRISTOPHER",
"AuthorizedOfficialTitle": "MANAGER/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "713-303-3189",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY.6828",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}