{
"Npi": {
"NPI": "1649655457",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CDA CLINICAL PHARMACY CORPORATION",
"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": "11441 HEACOCK ST",
"SecondLineMailingAddress": "STE D",
"MailingAddressCityName": "MORENO VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92557-7907",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-242-2540",
"MailingAddressFaxNumber": "951-242-1490",
"FirstLinePracticeLocationAddress": "11441 HEACOCK ST",
"SecondLinePracticeLocationAddress": "STE D",
"PracticeLocationAddressCityName": "MORENO VALLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92557-7907",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-242-2540",
"PracticeLocationAddressFaxNumber": "951-242-1490",
"EnumerationDate": "07/22/2015",
"LastUpdateDate": "07/28/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PADILLA",
"AuthorizedOfficialFirstName": "AMELIA",
"AuthorizedOfficialMiddleName": "GRACE",
"AuthorizedOfficialTitle": "CEO/RPH",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "951-242-2540",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY 53298",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}