{
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "2201 RAYBURN LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VIRGINIA BEACH",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23453-2879",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-734-7110",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1200 BATTLEFIELD BLVD N STE 103",
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"PracticeLocationAddressCityName": "CHESAPEAKE",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/17/2022",
"LastUpdateDate": "07/17/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POTNURI",
"AuthorizedOfficialFirstName": "DILEEP",
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"AuthorizedOfficialTelephoneNumber": "757-734-7110",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}