{
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"EIN": null,
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"FirstLineMailingAddress": "758 E 10TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HIALEAH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33010-3636",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-391-3907",
"MailingAddressFaxNumber": "786-391-3915",
"FirstLinePracticeLocationAddress": "758 E 10TH ST",
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"PracticeLocationAddressCityName": "HIALEAH",
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"PracticeLocationAddressFaxNumber": "786-391-3915",
"EnumerationDate": "08/13/2014",
"LastUpdateDate": "02/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAMACHO",
"AuthorizedOfficialFirstName": "CARLOS",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": null,
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}