{
"Npi": {
"NPI": "1518501592",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SOUTHWEST PHARMACY INC",
"ParentOrgTIN": null,
"OrgName": "SOUTHWEST PHARMACY INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "312 MARION AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MCCOMB",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39648-2708",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-684-9602",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3000 PLAZA DR STE B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TYLERTOWN",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39667-9227",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-377-1982",
"PracticeLocationAddressFaxNumber": "601-377-1980",
"EnumerationDate": "11/01/2019",
"LastUpdateDate": "08/25/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUY",
"AuthorizedOfficialFirstName": "JOE",
"AuthorizedOfficialMiddleName": "KEITH",
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "601-684-9602",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}