{
"Npi": {
"NPI": "1629501192",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SANFORD COMMUNITY 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": "1041 S ORANGE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEWARK",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07106-1716",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-351-0099",
"MailingAddressFaxNumber": "973-351-9505",
"FirstLinePracticeLocationAddress": "1041 S ORANGE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEWARK",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07106-1716",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-351-0099",
"PracticeLocationAddressFaxNumber": "973-351-9505",
"EnumerationDate": "04/11/2017",
"LastUpdateDate": "04/11/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GANDHI",
"AuthorizedOfficialFirstName": "PARESH",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "B.PHARM",
"AuthorizedOfficialTelephoneNumber": "646-417-3844",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "28RS00624800",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}