{
"Npi": {
"NPI": "1518038694",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CORNER PHARMACY CORPORATION",
"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": "2011 COYNE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HONOLULU",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96826-1334",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-946-0064",
"MailingAddressFaxNumber": "808-949-7131",
"FirstLinePracticeLocationAddress": "2011 COYNE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HONOLULU",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96826-1334",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-946-0064",
"PracticeLocationAddressFaxNumber": "808-949-7131",
"EnumerationDate": "11/12/2006",
"LastUpdateDate": "07/14/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MUDRICK",
"AuthorizedOfficialFirstName": "CARL",
"AuthorizedOfficialMiddleName": "PHILLIP",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "808-946-0064",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY685",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}