{
"Npi": {
"NPI": "1841006111",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WALLER RX PHARMACY, PLLC",
"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": "31303 FM 2920 RD STE H",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WALLER",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77484-8196",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "713-725-2211",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "31303 FM 2920 RD STE H",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WALLER",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77484-8196",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "713-725-2211",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/10/2024",
"LastUpdateDate": "12/10/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POWELL",
"AuthorizedOfficialFirstName": "JUNIOUS",
"AuthorizedOfficialMiddleName": "KEITH",
"AuthorizedOfficialTitle": "OWNER/PIC",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "713-725-2211",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}