{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRUNELLA PHARMACY LLC",
"LastName": null,
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"NamePrefix": null,
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"OtherLastName": null,
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"FirstLineMailingAddress": "17135 W CAPITOL DRIVE",
"SecondLineMailingAddress": "SUITE 110",
"MailingAddressCityName": "BROOKFIELD",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53005",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-777-6911",
"MailingAddressFaxNumber": "262-777-6910",
"FirstLinePracticeLocationAddress": "17135 W CAPITOL DR",
"SecondLinePracticeLocationAddress": "STE 110",
"PracticeLocationAddressCityName": "BROOKFIELD",
"PracticeLocationAddressStateName": "WI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-420-9525",
"PracticeLocationAddressFaxNumber": "414-296-8456",
"EnumerationDate": "08/01/2025",
"LastUpdateDate": "11/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAAD",
"AuthorizedOfficialFirstName": "FATMA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "262-420-9525",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}