{
"Npi": {
"NPI": "1497047112",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MANGO",
"FirstName": "LAWRENCE",
"MiddleName": "JOHN",
"NamePrefix": "MR.",
"NameSuffix": "SR.",
"Credential": "R.PH.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "141 HANNAFORD SQ",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BENNINGTON",
"MailingAddressStateName": "VT",
"MailingAddressPostalCode": "05201-1653",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "802-442-3642",
"MailingAddressFaxNumber": "802-442-3065",
"FirstLinePracticeLocationAddress": "141 HANNAFORD SQ",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BENNINGTON",
"PracticeLocationAddressStateName": "VT",
"PracticeLocationAddressPostalCode": "05201-1653",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-442-3642",
"PracticeLocationAddressFaxNumber": "802-442-3065",
"EnumerationDate": "05/13/2011",
"LastUpdateDate": "12/05/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "I036415",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "033-0002889",
"LicenseNumberStateCode": "VT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}