{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FARMACIA DEJIREH CORP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 548",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HUMACAO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00792-0548",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-852-2828",
"MailingAddressFaxNumber": "787-852-4622",
"FirstLinePracticeLocationAddress": "CARRETERA 3 URB BUZO",
"SecondLinePracticeLocationAddress": "443",
"PracticeLocationAddressCityName": "HUMACAO",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00791",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-852-2828",
"PracticeLocationAddressFaxNumber": "787-852-4622",
"EnumerationDate": "12/21/2007",
"LastUpdateDate": "11/19/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SERRANO",
"AuthorizedOfficialFirstName": "JACQUELINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "787-559-1137",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "15F2572",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}