{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CROWN VALLEY PHARMACY",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3720 SIERRA HWY",
"SecondLineMailingAddress": "UNIT G",
"MailingAddressCityName": "ACTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93510-1272",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "661-269-9500",
"MailingAddressFaxNumber": "661-269-9501",
"FirstLinePracticeLocationAddress": "3720 SIERRA HWY",
"SecondLinePracticeLocationAddress": "UNIT G",
"PracticeLocationAddressCityName": "ACTON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93510-1272",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "661-269-9500",
"PracticeLocationAddressFaxNumber": "661-269-9501",
"EnumerationDate": "02/22/2011",
"LastUpdateDate": "04/11/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHOWDHURY",
"AuthorizedOfficialFirstName": "JENISA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER, STORE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "661-269-9500",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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"LicenseNumber": "PHY51552",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}