{
"Npi": {
"NPI": "1629006291",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LEAVITT PHARMACY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2600 LAKE LUCIEN DR",
"SecondLineMailingAddress": "SUITE 180",
"MailingAddressCityName": "MAITLAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32751-7233",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-875-2080",
"MailingAddressFaxNumber": "407-875-0518",
"FirstLinePracticeLocationAddress": "187 SABAL PALM DR",
"SecondLinePracticeLocationAddress": "SUITE 102",
"PracticeLocationAddressCityName": "LONGWOOD",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32779-2595",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-478-2799",
"PracticeLocationAddressFaxNumber": "407-478-2798",
"EnumerationDate": "06/30/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORELL",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "TREASURER / SECRETARY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "407-875-2080",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH22020",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}