{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "JC MILLENNIUM ENTERPRISES, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6610 LAKE SHORE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GARLAND",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75044-2042",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-408-0417",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4926 COLUMBIA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DALLAS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75214-5506",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-408-0417",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/18/2018",
"LastUpdateDate": "03/27/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BALUYOT",
"AuthorizedOfficialFirstName": "JORDAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "STAFF PHARMACIST",
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"AuthorizedOfficialTelephoneNumber": "817-408-0417",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": "32030",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}