{
"Npi": {
"NPI": "1104125574",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "WALGREENS",
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"OrgName": "WALGREENS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1091 ROSEWOOD DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAPEVINE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76051-7807",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-926-3432",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7151 BLVD 26",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH RICHLAND HILLS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76180-8607",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-514-9474",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/24/2011",
"LastUpdateDate": "03/24/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTILLO",
"AuthorizedOfficialFirstName": "JORGE",
"AuthorizedOfficialMiddleName": "A.",
"AuthorizedOfficialTitle": "PHARMACIST- MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "718-926-3432",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "47343",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}