{
"Npi": {
"NPI": "1902125875",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "UNIVERSITY OF CONNECTICUT HEALTH CENTER",
"ParentOrgTIN": null,
"OrgName": "UCONN HEALTH CENTER PHARMACY",
"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": "263 FARMINGTON AVE",
"SecondLineMailingAddress": "MC 6202",
"MailingAddressCityName": "FARMINGTON",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06030-6202",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-679-7920",
"MailingAddressFaxNumber": "860-679-8020",
"FirstLinePracticeLocationAddress": "270 FARMINGTON AVE",
"SecondLinePracticeLocationAddress": "SUITE 108",
"PracticeLocationAddressCityName": "FARMINGTON",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06032-1909",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-679-7915",
"PracticeLocationAddressFaxNumber": "860-679-8020",
"EnumerationDate": "05/18/2010",
"LastUpdateDate": "05/18/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRESTMAN",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR CMHC",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "860-679-5596",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "282N00000X",
"TaxonomyName": "General Acute Care Hospital",
"LicenseNumber": "0065",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}