{
"Npi": {
"NPI": "1972892438",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PHALEN FAMILY PHARMACY LTD",
"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": "1001 JOHNSON PKWY # B23",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT PAUL",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55106-3474",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-209-9000",
"MailingAddressFaxNumber": "651-209-9009",
"FirstLinePracticeLocationAddress": "1001 JOHNSON PKWY STE B23",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT PAUL",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55106-3474",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "651-209-9000",
"PracticeLocationAddressFaxNumber": "651-209-9009",
"EnumerationDate": "04/05/2011",
"LastUpdateDate": "10/19/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LO",
"AuthorizedOfficialFirstName": "MAY",
"AuthorizedOfficialMiddleName": "XIA",
"AuthorizedOfficialTitle": "PHARMACIST/ OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "612-807-0269",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "263673",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}