{
"Npi": {
"NPI": "1609973445",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MULBERRY PHARMACY INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 767",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MULBERRY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33860-0767",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-425-1101",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1009 N CHURCH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MULBERRY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33860-2039",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-425-1101",
"PracticeLocationAddressFaxNumber": "863-425-1497",
"EnumerationDate": "09/20/2006",
"LastUpdateDate": "04/04/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SLAUGHTER",
"AuthorizedOfficialFirstName": "JEROLD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "863-425-1101",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0004X",
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},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "PH0001028",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}