{
"Npi": {
"NPI": "1245836097",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "YERKES",
"FirstName": "MARY",
"MiddleName": "C",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "RPH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PLONSKI",
"OtherFirstName": "MARY",
"OtherMiddleName": "C",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "RPH",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "36 FOREST AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVER FOREST",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60305-2002",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-860-8509",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "675 W NORTH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MELROSE PARK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60160-1630",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-538-4941",
"PracticeLocationAddressFaxNumber": "708-538-4673",
"EnumerationDate": "12/08/2020",
"LastUpdateDate": "12/08/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "051034318",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}