{
"Npi": {
"NPI": "1699932855",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NESHAMINY PHARMACY LLC",
"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": "1582 CLARK DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YARDLEY",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19067-4375",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "267-210-9795",
"MailingAddressFaxNumber": "215-493-6006",
"FirstLinePracticeLocationAddress": "5417 NESHAMINY BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BENSALEM",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19020-1782",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-757-4557",
"PracticeLocationAddressFaxNumber": "215-757-4559",
"EnumerationDate": "05/16/2008",
"LastUpdateDate": "06/29/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANZABI",
"AuthorizedOfficialFirstName": "ILHAMA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "267-210-9795",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PP481835",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}