{
"Npi": {
"NPI": "1518130590",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PHYSICIAN'S CHOICE DISPENSING SERVICES",
"ParentOrgTIN": null,
"OrgName": "MOHAMED SALEH DISPENSARY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2301 W SAMPLE RD",
"SecondLineMailingAddress": "SUITE 7A",
"MailingAddressCityName": "POMPANO BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33073-3081",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-935-6063",
"MailingAddressFaxNumber": "954-935-0470",
"FirstLinePracticeLocationAddress": "1408 SAN MARCO BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32207-8536",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-398-0009",
"PracticeLocationAddressFaxNumber": "904-346-0887",
"EnumerationDate": "04/10/2008",
"LastUpdateDate": "04/10/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EASON",
"AuthorizedOfficialFirstName": "CICELY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "954-935-6063",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332900000X",
"TaxonomyName": "Non-Pharmacy Dispensing Site",
"LicenseNumber": "ME43827",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}