{
"Npi": {
"NPI": "1932769684",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EXCEL SPECIALTY PHARMACY LLC",
"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": "3338 DUNCAN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLOVIS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93619-5007",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-375-1241",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "604 N MAGNOLIA AVE STE 105",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLOVIS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93611-9205",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-229-5481",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/15/2019",
"LastUpdateDate": "09/16/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EDEMA",
"AuthorizedOfficialFirstName": "ADEOLA",
"AuthorizedOfficialMiddleName": "O",
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "559-375-1241",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}