{
"Npi": {
"NPI": "1619119914",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TEXAS PROFESSIONAL PHARMACY 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": "17330 SPRING CYPRESS RD",
"SecondLineMailingAddress": "SUITE 160",
"MailingAddressCityName": "CYPRESS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77429-4293",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-213-3490",
"MailingAddressFaxNumber": "281-213-3919",
"FirstLinePracticeLocationAddress": "17330 SPRING CYPRESS RD",
"SecondLinePracticeLocationAddress": "SUITE 160",
"PracticeLocationAddressCityName": "CYPRESS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77429-4293",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-213-3490",
"PracticeLocationAddressFaxNumber": "281-213-3919",
"EnumerationDate": "04/01/2009",
"LastUpdateDate": "04/24/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GULAMHUSEIN",
"AuthorizedOfficialFirstName": "MUSTAFA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "V PRESIDENT, PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "281-859-1704",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "26588",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}