{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OK COMPOUNDING LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "102 N BROADWAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SKIATOOK",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74070",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-396-0100",
"MailingAddressFaxNumber": "918-396-0113",
"FirstLinePracticeLocationAddress": "102 N BROADWAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SKIATOOK",
"PracticeLocationAddressStateName": "OK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-396-0100",
"PracticeLocationAddressFaxNumber": "918-396-0113",
"EnumerationDate": "11/04/2010",
"LastUpdateDate": "05/08/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARKS",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PARTNER/MANAGING OFFICER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "918-396-0100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": "2-6161",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}