NPI Code Detail JSON Logo

1578860805 NPI number — BONNIE BRAE DRUGSTORE LLC

NPI Number: 1578860805
Health Care Provider/Practitioner: BONNIE BRAE DRUGSTORE LLC

Information about “1578860805” NPI (BONNIE BRAE DRUGSTORE LLC) exists in 1578860805 in HTML format HTML  |  1578860805 in plain Text format TXT  |  1578860805 in PDF (Portable Document Format) PDF  |  1578860805 in an XML format XML  formats.

NPI Number : 1578860805 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578860805",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BONNIE BRAE DRUGSTORE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2700 E LOUISIANA AVE APT 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DENVER",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80210-2009",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "303-722-7892",
    "MailingAddressFaxNumber": "720-223-7269",
    "FirstLinePracticeLocationAddress": "2700 E LOUISIANA AVE APT 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DENVER",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80210-2009",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-722-7892",
    "PracticeLocationAddressFaxNumber": "720-223-7269",
    "EnumerationDate": "02/23/2011",
    "LastUpdateDate": "02/15/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LAGER",
    "AuthorizedOfficialFirstName": "BENJAMIN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER/MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "303-722-7892",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "PDO-816",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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