{
"Npi": {
"NPI": "1659691103",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WELL-CARE PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3645 NORTHGATE BLVD",
"SecondLineMailingAddress": "SUITE F",
"MailingAddressCityName": "SACRAMENTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95834-1641",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-649-1615",
"MailingAddressFaxNumber": "916-649-1399",
"FirstLinePracticeLocationAddress": "3645 NORTHGATE BLVD",
"SecondLinePracticeLocationAddress": "SUITE F",
"PracticeLocationAddressCityName": "SACRAMENTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95834-1641",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-649-1615",
"PracticeLocationAddressFaxNumber": "916-649-1399",
"EnumerationDate": "06/08/2010",
"LastUpdateDate": "06/27/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YAMIN",
"AuthorizedOfficialFirstName": "MOBEEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "916-649-1615",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "56778",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}