{
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"EIN": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHARMACIST",
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"FirstLineMailingAddress": "PO BOX 457",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARUTHERS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93609-0457",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-864-3177",
"MailingAddressFaxNumber": "559-864-3497",
"FirstLinePracticeLocationAddress": "2436 W TAHOE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARUTHERS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "559-864-3177",
"PracticeLocationAddressFaxNumber": "559-864-3497",
"EnumerationDate": "02/08/2021",
"LastUpdateDate": "02/08/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pharmacist",
"LicenseNumber": "37004",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}