{
"Npi": {
"NPI": "1912323155",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MERCURY PHARMACY CORPORATION",
"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": "5233 REEDLEY WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CASTRO VALLEY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94546-1502",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-200-4411",
"MailingAddressFaxNumber": "707-652-5906",
"FirstLinePracticeLocationAddress": "3495 SONOMA BLVD STE K",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VALLEJO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94590-2984",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-200-4411",
"PracticeLocationAddressFaxNumber": "707-652-5906",
"EnumerationDate": "03/12/2014",
"LastUpdateDate": "08/20/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DUENAS",
"AuthorizedOfficialFirstName": "RICARDO",
"AuthorizedOfficialMiddleName": "ANGEL",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "707-200-4411",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "51790",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}