{
"Npi": {
"NPI": "1467924977",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BOLTON",
"FirstName": "AMANDA",
"MiddleName": "SUE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PHARMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4451 COUNTY ROAD 4410",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COMMERCE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75428-6821",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-375-4268",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3001 JOE RAMSEY BLVD E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENVILLE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75401-7714",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-455-7200",
"PracticeLocationAddressFaxNumber": "903-455-7300",
"EnumerationDate": "12/21/2018",
"LastUpdateDate": "04/20/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "62190",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}