{
"Npi": {
"NPI": "1619458981",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SIMPLYWELL SPECIALTY PHARMACY LP",
"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": "463128 STATE ROAD 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YULEE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32097-5554",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-468-3020",
"MailingAddressFaxNumber": "904-849-1627",
"FirstLinePracticeLocationAddress": "463128 STATE ROAD 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YULEE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32097-5554",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-468-8886",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/24/2018",
"LastUpdateDate": "03/19/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLAYTON",
"AuthorizedOfficialFirstName": "MADISON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "904-468-3020",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "31635",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}