{
"Npi": {
"NPI": "1225394760",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BEAUFORT PHARMACY AND COMPOUNDING LLC",
"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": "810 ELM ST E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAMPTON",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29924-2610",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "803-914-0318",
"MailingAddressFaxNumber": "803-914-0311",
"FirstLinePracticeLocationAddress": "810 ELM ST E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAMPTON",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29924-2610",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "803-914-0318",
"PracticeLocationAddressFaxNumber": "803-914-0311",
"EnumerationDate": "04/10/2012",
"LastUpdateDate": "12/01/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMMONS",
"AuthorizedOfficialFirstName": "JEREMY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "843-729-5583",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "15492",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}