{
"Npi": {
"NPI": "1740879097",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "VIC'S FAMILY PHARMACY INC",
"ParentOrgTIN": null,
"OrgName": "VIC'S FAMILY PHARMACY INC",
"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": "119 S VALLEY DR STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAMPA",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83686-2985",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-465-7000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "118 S MIDLAND BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NAMPA",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83686-2601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-442-1000",
"PracticeLocationAddressFaxNumber": "208-442-1091",
"EnumerationDate": "01/12/2021",
"LastUpdateDate": "01/21/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
"AuthorizedOfficialFirstName": "VICTOR",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "OWNER/PHARMACIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "208-465-7000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}