{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "BENNETT FAMILY PHARMACY INC",
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"NamePrefix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "764 KIO CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WATKINS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80137-8848",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-640-7698",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "110 CENTENNIAL DR UNIT A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BENNETT",
"PracticeLocationAddressStateName": "CO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-640-7698",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/12/2025",
"LastUpdateDate": "06/12/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIERWATOSKI",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": "PAUL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "970-640-7698",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}