{
"Npi": {
"NPI": "1649641309",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUPERIOR CARE 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": "9064 PULSAR CT",
"SecondLineMailingAddress": "SUITE G&H",
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92883-7354",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-785-3993",
"MailingAddressFaxNumber": "844-637-2447",
"FirstLinePracticeLocationAddress": "9064 PULSAR CT",
"SecondLinePracticeLocationAddress": "SUITE G&H",
"PracticeLocationAddressCityName": "CORONA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92883-7354",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-785-3993",
"PracticeLocationAddressFaxNumber": "844-637-2447",
"EnumerationDate": "10/07/2015",
"LastUpdateDate": "10/08/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ISHAQUE",
"AuthorizedOfficialFirstName": "DEREK",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "619-785-3993",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "PHY53762",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": "PHY53762",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}