{
"Npi": {
"NPI": "1831592492",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ASC PHARMACY, INC.",
"ParentOrgTIN": null,
"OrgName": "ASC PHARMACY, INC.",
"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": "3416 W 84TH ST",
"SecondLineMailingAddress": "SUITE 108A",
"MailingAddressCityName": "HIALEAH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33018-4933",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-698-5411",
"MailingAddressFaxNumber": "800-754-6602",
"FirstLinePracticeLocationAddress": "3416 W 84TH ST",
"SecondLinePracticeLocationAddress": "SUITE 108A",
"PracticeLocationAddressCityName": "HIALEAH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33018-4933",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-698-5411",
"PracticeLocationAddressFaxNumber": "800-754-6602",
"EnumerationDate": "09/26/2014",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SERNA",
"AuthorizedOfficialFirstName": "ASCANIO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "305-698-5411",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336S0011X",
"TaxonomyName": "Specialty Pharmacy",
"LicenseNumber": "PH28580",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}