{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "CVS",
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"NamePrefix": null,
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"FirstLineMailingAddress": "11181 BOESSOW RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GALT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95632-8321",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-369-3648",
"MailingAddressFaxNumber": "209-369-3104",
"FirstLinePracticeLocationAddress": "100 W LODI AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LODI",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-369-3648",
"PracticeLocationAddressFaxNumber": "209-369-3104",
"EnumerationDate": "11/03/2015",
"LastUpdateDate": "11/03/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAMURA",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "TADAO",
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"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "209-712-7055",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "40586",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}