{
"Npi": {
"NPI": "1578628285",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MALEZA EXPRESS PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "HC-01 BOX 13327",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AGUADILLA",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00603",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-890-5505",
"MailingAddressFaxNumber": "787-890-5515",
"FirstLinePracticeLocationAddress": "CARR. 110 KM. 8.9",
"SecondLinePracticeLocationAddress": "BO. MALEZA ALTA",
"PracticeLocationAddressCityName": "AGUADILLA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00603",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-890-5505",
"PracticeLocationAddressFaxNumber": "787-890-5515",
"EnumerationDate": "12/22/2006",
"LastUpdateDate": "06/25/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARNADEZ",
"AuthorizedOfficialFirstName": "OMAR",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-890-5505",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "07-F-2027",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}