{
"Npi": {
"NPI": "1992882286",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GOODFELLOW 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": "12157 VICTORY BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH HOLLYWOOD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91606-3204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-754-0949",
"MailingAddressFaxNumber": "818-754-0944",
"FirstLinePracticeLocationAddress": "12157 VICTORY BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH HOLLYWOOD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91606-3204",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-754-0949",
"PracticeLocationAddressFaxNumber": "818-754-0944",
"EnumerationDate": "11/01/2006",
"LastUpdateDate": "09/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DISHIGRIKIAN",
"AuthorizedOfficialFirstName": "MKRTICH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CPA",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "818-754-0949",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}