{
"Npi": {
"NPI": "1427484005",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRINITY WAY 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": "2650 JAMACHA RD. #147",
"SecondLineMailingAddress": "PMB 111",
"MailingAddressCityName": "EL CAJON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92108",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-933-4875",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9999 MIRA MESA BLVD",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92131-1006",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-933-4875",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/16/2013",
"LastUpdateDate": "01/03/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KATTOULA",
"AuthorizedOfficialFirstName": "YOUSIF",
"AuthorizedOfficialMiddleName": "HABIB",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "619-933-4875",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "04447-CA",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}