{
"Npi": {
"NPI": "1902109952",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MIRRA RX INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "14 MADISON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VALHALLA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10595-1900",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-361-1260",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "14 MADISON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VALHALLA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10595-1900",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "800-361-1260",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/14/2010",
"LastUpdateDate": "07/10/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MIRRA",
"AuthorizedOfficialFirstName": "JERRY",
"AuthorizedOfficialMiddleName": "DOMINICK",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "914-980-8321",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336S0011X",
"TaxonomyName": "Specialty Pharmacy",
"LicenseNumber": "030332",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}