{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "BOB'S GREENLEY PHARMACY INC",
"LastName": null,
"FirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "800 DELNERO DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SONORA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95370-5221",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "800 DELNERO DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SONORA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "220-953-2313",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/07/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "ROBERT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "209-532-3139",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "45274",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}