{
"Npi": {
"NPI": "1962950741",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BK PHARMACY CORP",
"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": "6741 N WILLOW AVE STE 106",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRESNO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93710-5955",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-325-6581",
"MailingAddressFaxNumber": "559-325-6627",
"FirstLinePracticeLocationAddress": "6741 N WILLOW AVE",
"SecondLinePracticeLocationAddress": "106",
"PracticeLocationAddressCityName": "FRESNO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93710-5955",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "559-297-8888",
"PracticeLocationAddressFaxNumber": "559-325-2888",
"EnumerationDate": "09/21/2016",
"LastUpdateDate": "08/22/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KONG",
"AuthorizedOfficialFirstName": "SHELDON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/ PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "559-297-8888",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "54539",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}