{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MEDICINE SHOPPES, INC",
"ParentOrgTIN": null,
"OrgName": "PHARMESTATE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "317 CENTRAL EXPY N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALLEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75013-2631",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-390-9888",
"MailingAddressFaxNumber": "972-390-9889",
"FirstLinePracticeLocationAddress": "317 CENTRAL EXPY N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALLEN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75013-2631",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-390-9888",
"PracticeLocationAddressFaxNumber": "972-390-9889",
"EnumerationDate": "02/08/2007",
"LastUpdateDate": "12/30/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCANALLY",
"AuthorizedOfficialFirstName": "BRUCE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "214-734-8878",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "15450",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}