{
"Npi": {
"NPI": "1053308940",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PARK WEST 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": "904 AUTUMN RD",
"SecondLineMailingAddress": "SUITE 275",
"MailingAddressCityName": "LITTLE ROCK",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72211-3702",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-224-3499",
"MailingAddressFaxNumber": "501-224-1140",
"FirstLinePracticeLocationAddress": "904 AUTUMN RD",
"SecondLinePracticeLocationAddress": "SUITE 275",
"PracticeLocationAddressCityName": "LITTLE ROCK",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72211-3702",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-224-3499",
"PracticeLocationAddressFaxNumber": "501-224-1140",
"EnumerationDate": "10/05/2005",
"LastUpdateDate": "09/12/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLOODWORTH",
"AuthorizedOfficialFirstName": "BILL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACY OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "501-224-3499",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "69175",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}