{
"Npi": {
"NPI": "1639545304",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DORADO PHARMACY INC",
"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": "13003 VAN NUYS BLVD",
"SecondLineMailingAddress": "UNIT #E",
"MailingAddressCityName": "PACOIMA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91331-8316",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-485-5554",
"MailingAddressFaxNumber": "818-485-5560",
"FirstLinePracticeLocationAddress": "13003 VAN NUYS BLVD STE E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PACOIMA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91331-8324",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-485-5554",
"PracticeLocationAddressFaxNumber": "818-485-5560",
"EnumerationDate": "08/18/2015",
"LastUpdateDate": "07/11/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DARROUJ",
"AuthorizedOfficialFirstName": "RAZAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "818-485-5554",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY53685",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}