{
"Npi": {
"NPI": "1568801058",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EL SHADDAI PHARMACY",
"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": "20 PEACOCK CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WASHINGTONVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10992-1708",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "739-732-6203",
"MailingAddressFaxNumber": "973-732-6204",
"FirstLinePracticeLocationAddress": "18 BLOOMFIELD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEWARK",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07104-2502",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-732-6203",
"PracticeLocationAddressFaxNumber": "973-732-6204",
"EnumerationDate": "06/18/2013",
"LastUpdateDate": "11/13/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DANQUAH",
"AuthorizedOfficialFirstName": "CYNTHIA",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "845-537-0399",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}