{
"Npi": {
"NPI": "1720337488",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE COMPOUNDING PHARMACY OF AMERICA",
"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": "6216 HIGHLAND PLACE WAY",
"SecondLineMailingAddress": "SUITE 101A",
"MailingAddressCityName": "KNOXVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37919-4070",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-972-7239",
"MailingAddressFaxNumber": "888-689-9892",
"FirstLinePracticeLocationAddress": "6216 HIGHLAND PLACE WAY",
"SecondLinePracticeLocationAddress": "SUITE 101A",
"PracticeLocationAddressCityName": "KNOXVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37919-4070",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "888-972-7239",
"PracticeLocationAddressFaxNumber": "888-689-9892",
"EnumerationDate": "09/09/2012",
"LastUpdateDate": "10/24/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POTEET",
"AuthorizedOfficialFirstName": "VINCENT",
"AuthorizedOfficialMiddleName": "MATTHEW",
"AuthorizedOfficialTitle": "CHIEF OPERATIONAL OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D.",
"AuthorizedOfficialTelephoneNumber": "404-805-3933",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": "05046",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}