{
"Npi": {
"NPI": "1861821399",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOONER PHARMACY OF OKLAHOMA LLC",
"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": "815 W BROADWAY AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SULPHUR",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73086-4611",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-622-2208",
"MailingAddressFaxNumber": "580-622-2212",
"FirstLinePracticeLocationAddress": "815 W BROADWAY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SULPHUR",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73086-4611",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-622-2208",
"PracticeLocationAddressFaxNumber": "580-622-2212",
"EnumerationDate": "11/05/2013",
"LastUpdateDate": "11/05/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HALL",
"AuthorizedOfficialFirstName": "JEREMY",
"AuthorizedOfficialMiddleName": "DEWAYNE",
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "580-622-2208",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "55-6470",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}