{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "Y",
"ParentOrgLBN": "BJRX PHARMACY LTC INC",
"ParentOrgTIN": null,
"OrgName": "STOCKTON PHARMACY",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1140 W HAMMER LN # D",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STOCKTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95209-3011",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-395-0555",
"MailingAddressFaxNumber": "209-451-3635",
"FirstLinePracticeLocationAddress": "1140 W HAMMER LN # D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STOCKTON",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-395-0555",
"PracticeLocationAddressFaxNumber": "209-451-3635",
"EnumerationDate": "04/15/2026",
"LastUpdateDate": "04/15/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANNE",
"AuthorizedOfficialFirstName": "PRATAP",
"AuthorizedOfficialMiddleName": "KRISHNA",
"AuthorizedOfficialTitle": "PHARMACY DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "209-395-0555",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}