{
"Npi": {
"NPI": "1407292816",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MOHAVE PHARMACY L.L.C.",
"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": "5225 S HIGHWAY 95 STE 9",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT MOHAVE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86426-9111",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5225 S HIGHWAY 95 STE 9",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT MOHAVE",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "86426-9111",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-768-3356",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/13/2013",
"LastUpdateDate": "05/13/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KRUGER",
"AuthorizedOfficialFirstName": "ERNST",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "928-234-5522",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "Y005643",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}