{
"Npi": {
"NPI": "1073547287",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIDDY'S PHARMACY, LLC",
"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": "4204 S FLORIDA AVE STE E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKELAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33813-1669",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-647-9899",
"MailingAddressFaxNumber": "863-709-0030",
"FirstLinePracticeLocationAddress": "4204 S FLORIDA AVE STE E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKELAND",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33813-1669",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-647-9899",
"PracticeLocationAddressFaxNumber": "863-709-0030",
"EnumerationDate": "07/11/2006",
"LastUpdateDate": "01/22/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIDDY",
"AuthorizedOfficialFirstName": "MELINDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "863-647-9899",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH19502",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}