{
"Npi": {
"NPI": "1720456908",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EGENTI",
"FirstName": "EMMANUEL",
"MiddleName": "OKEZIE",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "EGENTI",
"OtherFirstName": "EMMANUEL",
"OtherMiddleName": "OKEZIE",
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "RPH",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "350 WESTPARK WAY",
"SecondLineMailingAddress": "SUITE 300",
"MailingAddressCityName": "EULESS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76040-3964",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-545-6600",
"MailingAddressFaxNumber": "817-545-6667",
"FirstLinePracticeLocationAddress": "350 WESTPARK WAY",
"SecondLinePracticeLocationAddress": "SUITE 300",
"PracticeLocationAddressCityName": "EULESS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76040-3964",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-545-6600",
"PracticeLocationAddressFaxNumber": "817-545-6667",
"EnumerationDate": "09/04/2015",
"LastUpdateDate": "09/04/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "27886",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1835G0303X",
"TaxonomyName": "Geriatric Pharmacist",
"LicenseNumber": "27886",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1835P0018X",
"TaxonomyName": "Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"LicenseNumber": "27886",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "1835P1200X",
"TaxonomyName": "Pharmacotherapy Pharmacist",
"LicenseNumber": "27886",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1835P1300X",
"TaxonomyName": "Psychiatric Pharmacist",
"LicenseNumber": "27886",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}