{
"Npi": {
"NPI": "1932540325",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROFESSIONAL COMPOUNDING 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": "721 W WHITTIER BLVD",
"SecondLineMailingAddress": "SUITE H",
"MailingAddressCityName": "LA HABRA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90631-3759",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-694-5100",
"MailingAddressFaxNumber": "562-375-6276",
"FirstLinePracticeLocationAddress": "721 W WHITTIER BLVD",
"SecondLinePracticeLocationAddress": "SUITE H",
"PracticeLocationAddressCityName": "LA HABRA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90631-3759",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-694-5100",
"PracticeLocationAddressFaxNumber": "562-375-6276",
"EnumerationDate": "07/12/2013",
"LastUpdateDate": "07/12/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BELL",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "PRINCIPAL",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "562-694-5100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0004X",
"TaxonomyName": "Compounding Pharmacy",
"LicenseNumber": "51496",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}