{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MARKETPLACE PHARMACY GROUP LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1005",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PURVIS",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39475-1005",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-794-8634",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "157 SHELBY SPEIGHTS DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PURVIS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-794-8634",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/24/2023",
"LastUpdateDate": "01/24/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VIVIEN",
"AuthorizedOfficialFirstName": "AMY",
"AuthorizedOfficialMiddleName": "LINDSEY",
"AuthorizedOfficialTitle": "PHARMACIST-IN-CHARGE",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "601-436-7969",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}