{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KELLY DRUG 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": "125 E BROAD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MINEOLA",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75773-2001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-569-3882",
"MailingAddressFaxNumber": "903-569-3868",
"FirstLinePracticeLocationAddress": "125 E BROAD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MINEOLA",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75773-2001",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-569-3882",
"PracticeLocationAddressFaxNumber": "903-569-3868",
"EnumerationDate": "02/21/2025",
"LastUpdateDate": "02/21/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "KELLY",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "903-569-3884",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}