{
"Npi": {
"NPI": "1598630915",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SIDHU",
"FirstName": "RAJDEEP",
"MiddleName": null,
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "RPM-PHARMACIST-PHARM",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5901 W. BEHREND DR",
"SecondLineMailingAddress": "APT 3114",
"MailingAddressCityName": "GLENDALE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85308",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "602-772-8749",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4890 N. LITCHFIELD RD.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LITCHFIELD PARK",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85340",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "623-547-4799",
"PracticeLocationAddressFaxNumber": "623-536-5618",
"EnumerationDate": "10/07/2025",
"LastUpdateDate": "10/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "S027668",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}