{
"Npi": {
"NPI": "1760458848",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEWMAN PHARMACY/MEDISTAT",
"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": "755B MCRAE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOBILE",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36606-4538",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "251-450-0808",
"MailingAddressFaxNumber": "251-471-3673",
"FirstLinePracticeLocationAddress": "R2 AVE LUIS MUNOZ MARIN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAGUAS",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00725-6461",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-286-8545",
"PracticeLocationAddressFaxNumber": "787-286-8547",
"EnumerationDate": "02/27/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PLEDGER",
"AuthorizedOfficialFirstName": "JAINE",
"AuthorizedOfficialMiddleName": "BLEDSOE",
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "251-450-0808",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "2006003892",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}