{
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"FirstLineMailingAddress": "3191 S VAUGHN WAY # 102",
"SecondLineMailingAddress": null,
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-748-2449",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3191 S VAUGHN WAY UNIT 102",
"SecondLinePracticeLocationAddress": "UNIT 102",
"PracticeLocationAddressCityName": "AURORA",
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"PracticeLocationAddressFaxNumber": "720-748-5324",
"EnumerationDate": "06/03/2013",
"LastUpdateDate": "06/07/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOERNER",
"AuthorizedOfficialFirstName": "PAUL",
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"AuthorizedOfficialTitle": "PHARMACY MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "720-748-2449",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}