{
"Npi": {
"NPI": "1578974663",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LAN NGOC NGUYEN, PHARM.D.,,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": "1102 ORCHARD DR",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "ARLINGTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76012",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-617-3460",
"MailingAddressFaxNumber": "817-617-3458",
"FirstLinePracticeLocationAddress": "1102 ORCHARD DR.",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "ARLINGTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76012",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-617-3460",
"PracticeLocationAddressFaxNumber": "817-617-3458",
"EnumerationDate": "05/12/2014",
"LastUpdateDate": "05/12/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NGUYEN",
"AuthorizedOfficialFirstName": "LAN",
"AuthorizedOfficialMiddleName": "NGOC",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "817-617-3460",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "29254",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}