{
"Npi": {
"NPI": "1376965566",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SILVER LAKE PHARMACY, LLC.",
"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": "2705 COTTON CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EUSTIS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32726-2078",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-217-0487",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "32729 RADIO RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEESBURG",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34788-3900",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-217-0487",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/08/2014",
"LastUpdateDate": "06/18/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATEL",
"AuthorizedOfficialFirstName": "KAMLESH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACY MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "352-217-0487",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH27348",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}