{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BLANDING PHARMACY & MEDICAL SUPPLY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5136 BLANDING BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32210-7894",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-777-2223",
"MailingAddressFaxNumber": "904-777-2787",
"FirstLinePracticeLocationAddress": "5136 BLANDING BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-777-2223",
"PracticeLocationAddressFaxNumber": "904-777-2787",
"EnumerationDate": "04/05/2016",
"LastUpdateDate": "04/05/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "PATRICK",
"AuthorizedOfficialMiddleName": "JAMES",
"AuthorizedOfficialTitle": "OWNER/MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH",
"AuthorizedOfficialTelephoneNumber": "904-777-2223",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "PH25156",
"LicenseNumberStateCode": "FL",
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},
{
"TaxonomyCode": "3336C0004X",
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},
{
"TaxonomyCode": "333600000X",
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}