{
"Npi": {
"NPI": "1457341299",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MISSION PHARMACY",
"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": "22138 MISSION BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAYWARD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94541-2645",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-581-8540",
"MailingAddressFaxNumber": "510-581-5873",
"FirstLinePracticeLocationAddress": "22138 MISSION BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAYWARD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94541-2645",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-581-8540",
"PracticeLocationAddressFaxNumber": "510-581-5873",
"EnumerationDate": "10/24/2005",
"LastUpdateDate": "04/29/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAM",
"AuthorizedOfficialFirstName": "KAM",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "V.P.",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D.",
"AuthorizedOfficialTelephoneNumber": "510-813-8687",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY47164",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}