{
"Npi": {
"NPI": "1700461100",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MOHAMED AYAD, M.D., P.C.",
"ParentOrgTIN": null,
"OrgName": "BINGHAM PHARMACY, PLLC",
"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": "13320 W WARREN AVE STE B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DEARBORN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48126-1417",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-581-4451",
"MailingAddressFaxNumber": "313-581-7560",
"FirstLinePracticeLocationAddress": "13320 W WARREN AVE STE B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DEARBORN",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48126-1417",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-581-4451",
"PracticeLocationAddressFaxNumber": "313-581-7560",
"EnumerationDate": "03/17/2021",
"LastUpdateDate": "12/21/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AYAD",
"AuthorizedOfficialFirstName": "MOHAMED",
"AuthorizedOfficialMiddleName": "H.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "954-496-1430",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}