{
"Npi": {
"NPI": "1457848004",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HILLCREST PHARMACY, LLC",
"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": "2650 FM 407 E STE 145-103",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BARTONVILLE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76226-7012",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "225-937-4716",
"MailingAddressFaxNumber": "972-767-3134",
"FirstLinePracticeLocationAddress": "3065 N JOSEY LN STE 60",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARROLLTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75007-5348",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-394-4456",
"PracticeLocationAddressFaxNumber": "972-394-4457",
"EnumerationDate": "04/19/2018",
"LastUpdateDate": "02/23/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PENN",
"AuthorizedOfficialFirstName": "JOE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGING MEMBER/CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "972-394-4456",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "802975922",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}