{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "ASM PHARMACY-TENNESSEE, LLC",
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"FirstName": null,
"MiddleName": null,
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"Credential": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "224 N PARK AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREMONT",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68025-4964",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-753-2800",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7665 US HIGHWAY 70 STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BARTLETT",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38133-2099",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-625-3784",
"PracticeLocationAddressFaxNumber": "901-676-6134",
"EnumerationDate": "05/09/2022",
"LastUpdateDate": "05/09/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOFF",
"AuthorizedOfficialFirstName": "WALTER",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "847-680-3515",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}