{
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"FirstLineMailingAddress": "192 MAUMELLE VALLEY DR",
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"MailingAddressCityName": "MAUMELLE",
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"MailingAddressPostalCode": "72113-7618",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-604-3210",
"MailingAddressFaxNumber": "501-604-3211",
"FirstLinePracticeLocationAddress": "6420 COLONEL GLENN RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LITTLE ROCK",
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"PracticeLocationAddressTelephoneNumber": "501-604-3210",
"PracticeLocationAddressFaxNumber": "501-604-3211",
"EnumerationDate": "05/12/2023",
"LastUpdateDate": "07/22/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ACHOR",
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"AuthorizedOfficialCredential": "PHARMD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}