{
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"NPI": "1831238880",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "PROSCRIPT PHARMACY MGMT LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1441 SOUTH AVE STE 703",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STATEN ISLAND",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10314-3784",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1441 SOUTH AVE STE 703",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STATEN ISLAND",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10314-3784",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "866-646-1780",
"PracticeLocationAddressFaxNumber": "347-897-4660",
"EnumerationDate": "02/06/2007",
"LastUpdateDate": "06/26/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEBARTOLOME",
"AuthorizedOfficialFirstName": "GINA",
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"AuthorizedOfficialTitle": "COO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "347-897-4670",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336M0002X",
"TaxonomyName": "Mail Order Pharmacy",
"LicenseNumber": "026894",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}