{
"Npi": {
"NPI": "1194897173",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "REDFISH PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1023 NORTH MAIN",
"SecondLineMailingAddress": "P O BOX 297",
"MailingAddressCityName": "JEWETT",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75846",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-626-5414",
"MailingAddressFaxNumber": "903-626-6062",
"FirstLinePracticeLocationAddress": "1023 N MAIN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JEWETT",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75846",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-626-5414",
"PracticeLocationAddressFaxNumber": "903-626-6062",
"EnumerationDate": "11/14/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MERRIMAN",
"AuthorizedOfficialFirstName": "HOMER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "903-636-5414",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "18232",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}