{
"Npi": {
"NPI": "1750506796",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHURN CREEK PHARMACY, INC.",
"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": "3330 CHURN CREEK RD",
"SecondLineMailingAddress": "SUITE A1",
"MailingAddressCityName": "REDDING",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "96002-2532",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "530-222-3038",
"MailingAddressFaxNumber": "530-222-0337",
"FirstLinePracticeLocationAddress": "3330 CHURN CREEK RD",
"SecondLinePracticeLocationAddress": "SUITE A1",
"PracticeLocationAddressCityName": "REDDING",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "96002-2532",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-222-3038",
"PracticeLocationAddressFaxNumber": "530-222-0337",
"EnumerationDate": "04/16/2007",
"LastUpdateDate": "10/20/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FRUZZA",
"AuthorizedOfficialFirstName": "EDWARD",
"AuthorizedOfficialMiddleName": "LOUIS",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "530-222-3038",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PHY324920",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}