{
"Npi": {
"NPI": "1669826178",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "T-RX PHARMACY",
"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": "211 HANCOCK BRIDGE PKWY",
"SecondLineMailingAddress": "SUITE #7",
"MailingAddressCityName": "CAPE CORAL",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33990-4021",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "239-677-4945",
"MailingAddressFaxNumber": "239-800-4854",
"FirstLinePracticeLocationAddress": "211 HANCOCK BRIDGE PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAPE CORAL",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33990-4021",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-677-4945",
"PracticeLocationAddressFaxNumber": "239-800-4854",
"EnumerationDate": "04/20/2016",
"LastUpdateDate": "03/30/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORDISCO",
"AuthorizedOfficialFirstName": "TERRY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT/PIC/AO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "239-989-9152",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH30057",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}