{
"Npi": {
"NPI": "1558612192",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PENG",
"FirstName": "QIU",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHARM.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3970 VALLEY GATEWAY BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROANOKE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24012-6773",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-977-6481",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "137 NORTH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOULTON",
"PracticeLocationAddressStateName": "ME",
"PracticeLocationAddressPostalCode": "04730-1832",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-532-6876",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/23/2012",
"LastUpdateDate": "01/27/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "PR12539",
"LicenseNumberStateCode": "ME",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1835P0018X",
"TaxonomyName": "Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"LicenseNumber": "0202212053",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}