{
"Npi": {
"NPI": "1881914471",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INNOVA PHARMACY, INC.",
"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": "40 WESTON ST",
"SecondLineMailingAddress": "SUITE G",
"MailingAddressCityName": "HARTFORD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06120-1538",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-825-7880",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "40 WESTON ST",
"SecondLinePracticeLocationAddress": "SUITE G",
"PracticeLocationAddressCityName": "HARTFORD",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06120-1538",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-825-7880",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/04/2010",
"LastUpdateDate": "06/04/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOSOSKI",
"AuthorizedOfficialFirstName": "LAWRENCE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "877-825-7880",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "PCY.2179",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}