{
"Npi": {
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUGARLOAF PKWY PHARMACY 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": "4955 SUGARLOAF PKWY STE 124",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAWRENCEVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30044-8838",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-223-3373",
"MailingAddressFaxNumber": "678-223-3302",
"FirstLinePracticeLocationAddress": "4955 SUGARLOAF PKWY STE 124",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAWRENCEVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30044-8838",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-223-3373",
"PracticeLocationAddressFaxNumber": "678-223-3302",
"EnumerationDate": "07/12/2021",
"LastUpdateDate": "06/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DONKOR",
"AuthorizedOfficialFirstName": "KENNEDY",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "678-223-3373",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}