{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RENGE PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "833 F ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRESNO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93706-3418",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-264-2808",
"MailingAddressFaxNumber": "559-264-1852",
"FirstLinePracticeLocationAddress": "833 F ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FRESNO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "559-264-2808",
"PracticeLocationAddressFaxNumber": "559-264-1852",
"EnumerationDate": "08/05/2006",
"LastUpdateDate": "05/25/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RENGE",
"AuthorizedOfficialFirstName": "MELVIN",
"AuthorizedOfficialMiddleName": "K.",
"AuthorizedOfficialTitle": "OWNER/PHARMACIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM. D.",
"AuthorizedOfficialTelephoneNumber": "559-264-2808",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "RPH 33277",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
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},
{
"TaxonomyCode": "333600000X",
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"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY 21926",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}