{
"Npi": {
"NPI": "1659072783",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KAWAHARA",
"FirstName": "NANCY",
"MiddleName": "EDMAN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PHARM.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "EDMAN",
"OtherFirstName": "NANCY",
"OtherMiddleName": "JULIA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 79552",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92877-0185",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-660-9181",
"MailingAddressFaxNumber": "909-558-7973",
"FirstLinePracticeLocationAddress": "24745 STEWART ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOMA LINDA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92350-1719",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-558-7401",
"PracticeLocationAddressFaxNumber": "909-558-7973",
"EnumerationDate": "03/15/2023",
"LastUpdateDate": "03/15/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "051-036720",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "37215",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}