{
"Npi": {
"NPI": "1700811007",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EL PASEO 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": "1605 EL PASEO RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAS CRUCES",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "88001-6013",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-541-1500",
"MailingAddressFaxNumber": "505-541-5929",
"FirstLinePracticeLocationAddress": "1605 EL PASEO RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAS CRUCES",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "88001-6013",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-541-1500",
"PracticeLocationAddressFaxNumber": "505-541-5929",
"EnumerationDate": "07/12/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ADAMS",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "FRANCIS",
"AuthorizedOfficialTitle": "PHARMACIST/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH.",
"AuthorizedOfficialTelephoneNumber": "505-541-1500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH-2812",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}