{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRIMARY CARE PHARMACY SERVICES INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "27 HECKEL ROAD",
"SecondLineMailingAddress": "SUITE 110",
"MailingAddressCityName": "MCKEES ROCKS",
"MailingAddressStateName": "PA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "412-771-2149",
"MailingAddressFaxNumber": "412-771-2169",
"FirstLinePracticeLocationAddress": "27 HECKEL ROAD",
"SecondLinePracticeLocationAddress": "SUITE 110",
"PracticeLocationAddressCityName": "MCKEES ROCKS",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "412-771-2149",
"PracticeLocationAddressFaxNumber": "412-771-2169",
"EnumerationDate": "11/23/2009",
"LastUpdateDate": "05/26/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERTOLA",
"AuthorizedOfficialFirstName": "ANTHONY",
"AuthorizedOfficialMiddleName": "F.",
"AuthorizedOfficialTitle": "PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "412-583-6332",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": "PP481981",
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"PrimaryTaxonomySwitch": "N"
},
{
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},
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "PP481981",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}