{
"Npi": {
"NPI": "1255566287",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CRANDALL CITY MARKET INC",
"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": "200 E RENFRO ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BURLESON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76028-3917",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-295-1051",
"MailingAddressFaxNumber": "817-295-2041",
"FirstLinePracticeLocationAddress": "3563 ALTON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT WORTH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76109-2834",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-429-2571",
"PracticeLocationAddressFaxNumber": "817-921-6075",
"EnumerationDate": "05/20/2009",
"LastUpdateDate": "12/10/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JAEGER",
"AuthorizedOfficialFirstName": "KURT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER & PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "817-429-2571",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "26418",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}