{
"Npi": {
"NPI": "1689756462",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FULCRUM PHARMACY MANAGEMENT INC",
"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": "PO BOX 2695",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILMINGTON",
"MailingAddressStateName": "DE",
"MailingAddressPostalCode": "19805-0695",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-658-8020",
"MailingAddressFaxNumber": "302-658-8024",
"FirstLinePracticeLocationAddress": "501 N SHIPLEY ST",
"SecondLinePracticeLocationAddress": "UNIT 1",
"PracticeLocationAddressCityName": "WILMINGTON",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19801-2252",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-658-8020",
"PracticeLocationAddressFaxNumber": "302-658-8024",
"EnumerationDate": "10/20/2006",
"LastUpdateDate": "10/23/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRKVENAC",
"AuthorizedOfficialFirstName": "CHRISTY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "302-658-8020",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": "A30000888",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}