{
"Npi": {
"NPI": "1770236044",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA",
"ParentOrgTIN": null,
"OrgName": "TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA",
"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": "625 CLARK AVE STE 10",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KING OF PRUSSIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19406-4025",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-992-3920",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "625 CLARK AVE STE 10",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KING OF PRUSSIA",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19406-4025",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-992-3920",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/27/2022",
"LastUpdateDate": "01/27/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEVANS",
"AuthorizedOfficialFirstName": "GENEVIEVE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ASSOCIATE DIRECTOR OF PHARMACY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "215-796-2085",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336H0001X",
"TaxonomyName": "Home Infusion Therapy Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336S0011X",
"TaxonomyName": "Specialty Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}