{
"Npi": {
"NPI": "1336574375",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHCARE PHARMACY 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": "PO BOX 580",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MCDONOUGH",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30253-0580",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-474-7693",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "405 SE 1ST AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TRENTON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32693-3219",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-463-2240",
"PracticeLocationAddressFaxNumber": "352-463-1645",
"EnumerationDate": "09/10/2013",
"LastUpdateDate": "01/17/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRAND",
"AuthorizedOfficialFirstName": "CARLY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "727-344-3902",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "PH27140",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}