{
"Npi": {
"NPI": "1770023574",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NATIONWIDE COMPOUNDING RX LLC",
"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": "14000 N HAYDEN RD STE 185",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SCOTTSDALE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85260-5561",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-499-8379",
"MailingAddressFaxNumber": "480-699-5341",
"FirstLinePracticeLocationAddress": "14000 N HAYDEN RD STE 185",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SCOTTSDALE",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85260-5561",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-499-8379",
"PracticeLocationAddressFaxNumber": "480-699-5341",
"EnumerationDate": "02/28/2017",
"LastUpdateDate": "02/28/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAMILTON",
"AuthorizedOfficialFirstName": "KYNSI",
"AuthorizedOfficialMiddleName": "LEIGH",
"AuthorizedOfficialTitle": "DIRECTOR OF PHARMACY",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "480-499-8379",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": "Y006765",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}