{
"Npi": {
"NPI": "1336574003",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WHOLE LIFE PHARMACY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2465 US 1 S STE 62",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ST AUGUSTINE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32086-6076",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-827-0177",
"MailingAddressFaxNumber": "855-319-9872",
"FirstLinePracticeLocationAddress": "10575 DIXIE HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PONTE VEDRA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32081",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-827-0177",
"PracticeLocationAddressFaxNumber": "855-319-9872",
"EnumerationDate": "09/12/2013",
"LastUpdateDate": "01/23/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HEATH",
"AuthorizedOfficialFirstName": "TIFFANY",
"AuthorizedOfficialMiddleName": "AMBER",
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "904-827-0177",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH27103",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}