{
"Npi": {
"NPI": "1548606403",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PETMART PHARMACY, LLC",
"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": "2404 E BROADWAY AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARYVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37804-2759",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-220-6337",
"MailingAddressFaxNumber": "888-908-0198",
"FirstLinePracticeLocationAddress": "2207 E BROADWAY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARYVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37804-3078",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-220-6337",
"PracticeLocationAddressFaxNumber": "888-908-0198",
"EnumerationDate": "05/20/2013",
"LastUpdateDate": "05/10/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABBOTT",
"AuthorizedOfficialFirstName": "EMILY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIS IN CHARGE",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D.",
"AuthorizedOfficialTelephoneNumber": "877-220-6337",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336M0002X",
"TaxonomyName": "Mail Order Pharmacy",
"LicenseNumber": "4885",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}