{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
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"OrgName": "CHILDREN'S HOSPITAL OF PHILADELPHIA",
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 785166",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19178-2033",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-590-5288",
"MailingAddressFaxNumber": "215-590-1906",
"FirstLinePracticeLocationAddress": "3401 CIVIC CENTER BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHILADELPHIA",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19104-4319",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "267-425-8888",
"PracticeLocationAddressFaxNumber": "215-590-0455",
"EnumerationDate": "10/03/2006",
"LastUpdateDate": "01/31/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATEL",
"AuthorizedOfficialFirstName": "NEIL",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "DIRECTOR, RETAIL PHARMACY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "215-590-5288",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PP481628",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}