{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UNIVERSAL PHARMACY",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"FirstLineMailingAddress": "4888 NW 183RD ST",
"SecondLineMailingAddress": "UNIT #105",
"MailingAddressCityName": "MIAMI GARDENS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33055-2900",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-657-3476",
"MailingAddressFaxNumber": "786-657-3280",
"FirstLinePracticeLocationAddress": "4888 NW 183RD ST STE 105",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIAMI GARDENS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33055-2939",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "786-657-3476",
"PracticeLocationAddressFaxNumber": "786-657-3280",
"EnumerationDate": "04/30/2014",
"LastUpdateDate": "06/15/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALEJO SARDUY",
"AuthorizedOfficialFirstName": "MAURICIO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "786-657-3664",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0004X",
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336L0003X",
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},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH28079",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}