{
"Npi": {
"NPI": "1942687116",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FREEDOM PHARMACY LLC",
"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": "3605 EDGMONT AVE",
"SecondLineMailingAddress": "BUILDING B",
"MailingAddressCityName": "BROOKHAVEN",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19015-2807",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "855-539-7865",
"MailingAddressFaxNumber": "866-250-1718",
"FirstLinePracticeLocationAddress": "3605 EDGMONT AVE",
"SecondLinePracticeLocationAddress": "BUILDING B",
"PracticeLocationAddressCityName": "BROOKHAVEN",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19015-2807",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "855-539-7865",
"PracticeLocationAddressFaxNumber": "866-250-1718",
"EnumerationDate": "04/27/2015",
"LastUpdateDate": "01/25/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WICK",
"AuthorizedOfficialFirstName": "KELLY",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "855-539-7865",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PP481827",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}