{
"Npi": {
"NPI": "1255474102",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THIRTEENTH AVENUE PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "216 S 13TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAUREL",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39440-4226",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-428-7257",
"MailingAddressFaxNumber": "601-428-0074",
"FirstLinePracticeLocationAddress": "216 S 13TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAUREL",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39440-4226",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-428-7257",
"PracticeLocationAddressFaxNumber": "601-428-0074",
"EnumerationDate": "02/14/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAULDIN",
"AuthorizedOfficialFirstName": "KYLE",
"AuthorizedOfficialMiddleName": "AARON",
"AuthorizedOfficialTitle": "PHARMACIST OWENER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "601-428-7257",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "01527 01.1",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}