{
"Npi": {
"NPI": "1295145605",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BAYSHORE HEALTH MART, 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": "3315 BURKE RD STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PASADENA",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77504-1873",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-984-5000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3315 BURKE RD STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PASADENA",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77504-1873",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "833-322-9746",
"PracticeLocationAddressFaxNumber": "833-322-9746",
"EnumerationDate": "05/07/2014",
"LastUpdateDate": "09/22/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MESURIA",
"AuthorizedOfficialFirstName": "PIYUSH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "833-322-9746",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "29025",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}