{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4060 N ARMENIA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TAMPA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33607-1002",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-870-3939",
"MailingAddressFaxNumber": "813-870-3933",
"FirstLinePracticeLocationAddress": "4060 N ARMENIA AVE",
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"PracticeLocationAddressCityName": "TAMPA",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "813-870-3939",
"PracticeLocationAddressFaxNumber": "813-870-3933",
"EnumerationDate": "10/07/2006",
"LastUpdateDate": "09/11/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VYAS",
"AuthorizedOfficialFirstName": "PRITI",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "813-870-3939",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH19463",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}