{
"Npi": {
"NPI": "1891266607",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SAINT CLAIR SHORES PHARMACY 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": "23600 HARPER AVE STE 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT CLAIR SHORES",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48080-1445",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-350-0370",
"MailingAddressFaxNumber": "586-350-0375",
"FirstLinePracticeLocationAddress": "23600 HARPER AVE STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT CLAIR SHORES",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48080-1445",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-350-0370",
"PracticeLocationAddressFaxNumber": "586-350-0375",
"EnumerationDate": "12/06/2018",
"LastUpdateDate": "12/06/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RESLAN",
"AuthorizedOfficialFirstName": "AHMAD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "586-350-0370",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}