{
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"FirstLineMailingAddress": "1106 W WILLOW RD",
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"MailingAddressCityName": "ENID",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73703-2599",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-234-5494",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1106 W WILLOW RD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-234-4343",
"PracticeLocationAddressFaxNumber": "580-234-5477",
"EnumerationDate": "07/19/2006",
"LastUpdateDate": "09/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NUNLEY",
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"AuthorizedOfficialTelephoneNumber": "580-234-4343",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}