{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "LOCH RAVEN PHARMACY INC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1101 N CALVERT ST UNIT 3",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BALTIMORE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21202-3840",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-433-9434",
"MailingAddressFaxNumber": "410-433-9436",
"FirstLinePracticeLocationAddress": "1101 N CALVERT ST UNIT 3",
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"PracticeLocationAddressCityName": "BALTIMORE",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-433-9434",
"PracticeLocationAddressFaxNumber": "410-433-9436",
"EnumerationDate": "04/09/2010",
"LastUpdateDate": "10/31/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YOUSUF",
"AuthorizedOfficialFirstName": "ANWAR",
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"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "410-323-1515",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
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"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}